NPIMap

Organization Active NPI

George L. Rodriguez, M.D., P.C.

  • Radiology Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1184830564
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
GEORGE L. RODRIGUEZ, M.D., P.C.
Doing business as
University Dynamic MRI
Practice address
841 E Allegheny Ave
Philadelphia, PA 19134-2401
Phone
(215) 425-1500
Fax
(215) 425-1659
NPI assigned
May 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Ellen C. Bamba
Title
Administrative Director
Phone
(215) 425-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

841 E Allegheny Ave
Philadelphia, PA 19134-2401

Mailing address

841 E Allegheny Ave
Philadelphia, PA 19134-2401
Phone (215) 425-1500

Other identifiers 1

IdentifierTypeStateIssuer
045575900OtherPAINDEPENDENCE BLUE CROSS/PERSONAL CHOICE

Other names 1

  • University Dynamic MRI Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040714000406 PA Part B Supplier - Clinic/Group Practice 7517946643 Receives reassigned benefits from 9 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brookhaven, PA; Wyncote, PA; Woodlyn, PA; Trevose, PA; Philadelphia, PA; Malvern, PA; Bala Cynwyd, PA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
George L Rodriguez MD PC28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1184830564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 E ALLEGHENY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191342401",
            "telephone_number": "215-425-1500",
            "fax_number": "215-425-1659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 E ALLEGHENY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191342401",
            "telephone_number": "215-425-1500",
            "fax_number": "215-425-1659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE L. RODRIGUEZ, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "BAMBA",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "215-425-1500"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS/PERSONAL CHOICE",
            "identifier": "045575900",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Dynamic MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.