Jason L Roddick, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA18638 Issued in CA

Practice address

25815 Barton Rd Ste 101
Loma Linda, CA 92354-3894

Phone

(909) 796-0224

Fax

(909) 796-0225

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Csi Medical Group

  • MOHS-Micrographic Surgery Physician
  • San Pedro, CA
  • NPI 1871909804
  Medicare reassignment
• David B. Friedman, MD, Inc

  • Procedural Dermatology Physician
  • Anaheim, CA
  • NPI 1164620795
  NPD
• K. D. Macknet, M.D., Inc.

  dba Loma Linda Dermatology Medical Group

  • Dermatology Physician
  • Loma Linda, CA
  • NPI 1083791644
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1164509899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25815 BARTON RD",
            "address_2": "STE 101",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543894",
            "telephone_number": "909-796-0224",
            "fax_number": "909-796-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25815 BARTON RD STE 101",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543894",
            "telephone_number": "909-796-0224",
            "fax_number": "909-796-0225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1165 N Euclid St",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928011938",
            "country_code": "US",
            "telephone_number": "714-991-9990",
            "fax_number": "714-991-9496",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "289 W Huntington Dr Ste 208",
            "address_purpose": "LOCATION",
            "city": "Arcadia",
            "state": "CA",
            "postal_code": "910073495",
            "country_code": "US",
            "telephone_number": "626-446-8809",
            "fax_number": "626-446-8268",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1620 E 2nd St Ste N",
            "address_purpose": "LOCATION",
            "city": "Beaumont",
            "state": "CA",
            "postal_code": "922233172",
            "country_code": "US",
            "telephone_number": "951-845-6500",
            "fax_number": "909-796-0225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "573 W Putnam Ave",
            "address_purpose": "LOCATION",
            "city": "Porterville",
            "state": "CA",
            "postal_code": "932573270",
            "country_code": "US",
            "telephone_number": "559-781-1812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODDICK",
        "first_name": "JASON",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18638",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA18638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PTAN",
            "identifier": "AR447Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jorge Luis Robledo, MD
• Antonio E Robles, M.D.
• Melanio Dylan Daus Robles II
• Natalit Kazandra Robles
• Susan Roche, D.D.S.
• Michelle Leann Roddy
• Sarah Roddy, M.D.
• Brock Reginald Rodgers, DNP
• Sofia Rodriguez Lopez, DDS
• Dannia E. Rodriguez, DPT

• Surgical Physician Assistant in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.