Active NPI
Sergio Ulises Rodas, M.D.
- Family Medicine Physician
- San Juan Capistrano, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G55286
- Practice address
- 30300 Camino Capistrano
San Juan Capistrano, CA 92675-1304 - Phone
- (949) 240-2030
- Fax
- (949) 240-5869
- NPI assigned
- Feb 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G55286 | CA | Primary |
Addresses
Primary practice location
30300 Camino Capistrano
San Juan Capistrano, CA 92675-1304
Mailing address
30300 Camino Capistrano
San Juan Capistrano, CA 92675-1304
Phone (949) 240-2030
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G552860 | Other | CA | MEDICAL |
| 00G552860B12 | Other | CA | CALOPTIMA |
Medicare participation
Medicare enrollment files- 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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of California, Irvine, California College of Medicine, 1984
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
30300 Camino Capistrano
San Juan Capistrano, CA 92675-1304
Phone 9492402330235
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Camino Health Center | Current | Accepting new patients | |
| Camino Health Center | Current | Accepting new patients |
Locations
30300 Camino Capistrano
San Juan Capo, CA 92675
Phone (949) 240-2030
Interoperability endpoints
- sergiorodas@chcca.allscriptsdirect.net
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Camino Health Center Lake Forest | Federally qualified health center | Corporate Officer W-2 Managing Employee |
Dec 1, 1997 Dec 1, 1997 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Federally Qualified Health Center (FQHC)
- Lake Forest, CA
- NPI 1194274811
Corporate Officer, W-2 Managing Employee
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community Health Clinic/Center
- San Juan Capistrano, CA
- NPI 1366560393
-
- Federally Qualified Health Center (FQHC)
- Lake Forest, CA
- NPI 1194274811
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Providence at Home with Compassus Home Health, Orange County
- Home Health Agency
- Anaheim, CA
- NPI 1588486716
-
dba Providence Mission Hospital
- General Acute Care Hospital
- Mission Viejo, CA
- NPI 1912108002
-
dba Mission Hospital
- General Acute Care Hospital
- Mission Viejo, CA
- NPI 1992752315
-
- General Acute Care Hospital
- Laguna Hills, CA
- NPI 1275576381
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489449600000",
"number": "1194869693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30300 CAMINO CAPISTRANO",
"city": "SAN JUAN CAPISTRANO",
"state": "CA",
"postal_code": "926751304",
"telephone_number": "949-240-2030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30300 CAMINO CAPISTRANO",
"city": "SAN JUAN CAPISTRANO",
"state": "CA",
"postal_code": "926751304",
"telephone_number": "949-240-2030",
"fax_number": "949-240-5869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODAS",
"first_name": "SERGIO",
"middle_name": "ULISES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-16",
"last_updated": "2017-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G55286",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL",
"identifier": "00G552860",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALOPTIMA",
"identifier": "00G552860B12",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Juan Capistrano, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.