Individual provider Active NPI

Jose Hiram Rodriguez, MD

  • Family Medicine Physician
  • Portsmouth, VA
National Provider Identifier
1164554523
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101054792 Issued in VA
Practice address
4106 Portsmouth Blvd
Portsmouth, VA 23701
Phone
(757) 393-1136
Fax
(757) 698-2499
NPI assigned
Mar 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101054792 VA Primary

Addresses

Primary practice location

4106 Portsmouth Blvd
Portsmouth, VA 23701

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (305) 628-6117

Other practice location 1

9581 Shore Drive
Norfolk, VA 23518-1711
Phone (757) 932-1601

Other practice location 2

9581 Shore Drive
Norfolk, VA 23518-1711
Phone (757) 932-1601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170522002136 VA Practitioner - Internal Medicine 2163548918

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
PMR Virginia Holding, LLC CurrentSince Apr 1, 2021 Accepting new patients

Locations

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

524 Southpark Blvd
Colonial Hgts, VA 23834
Phone (804) 504-7980

4106 Portsmouth Blvd
Portsmouth, VA 23701
Phone (757) 391-2850

3806 Mechanicsville Tpke
Richmond, VA 23223
Phone (804) 228-1143

6550 Hull St Rd
Richmond, VA 23224
Phone (804) 674-3425

5516 Virginia Beach Blvd
Virginia Beach, VA 23462
Phone (757) 287-3699

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1164554523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 PORTSMOUTH BLVD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "23701",
            "telephone_number": "757-393-1136",
            "fax_number": "757-698-2499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9581 Shore Drive",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235181711",
            "country_code": "US",
            "telephone_number": "757-932-1601",
            "fax_number": "757-227-6168",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9581 Shore Drive",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235181711",
            "country_code": "US",
            "telephone_number": "757-932-1601",
            "fax_number": "757-227-6168",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "JOSE",
        "middle_name": "HIRAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101054792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, VA

Sources for this page

Verify at the official NPI Registry.