Individual provider Active NPI

Sergio Enrique Rodriguez, PA-C

  • Physician Assistant
  • Salinas, CA
National Provider Identifier
1205370160
Registry record updated Dec 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
54001 Issued in CA
Practice address
1441 Constitution Blvd
Salinas, CA 93906-3100
Phone
(831) 755-4111
NPI assigned
Dec 12, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 54001 CA Primary

Addresses

Primary practice location

1441 Constitution Blvd
Salinas, CA 93906-3100

Mailing address

1804 Bradbury St
Salinas, CA 93906-4686
Phone (831) 676-6457

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170203001278 CA Practitioner - Physician Assistant 9234412974 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
54001CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America- California CurrentSince Feb 1, 2017 Accepting new patients
Valle Verde Medical Group Inc Current Accepting new patients
Santa Lucia Medical Group, Inc. Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1332 Natividad Rd
Ste C
Salinas, CA 93906
Phone (831) 754-1544

1441 Constitution Blvd
Salinas, CA 93906
Phone (831) 261-8090

Interoperability endpoints

  • Direct secure messaging: srodriguez18252@direct.svmh.com

Organizations & group practices 5

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": "1481500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481500800000",
    "number": "1205370160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 BRADBURY ST",
            "city": "SALINAS",
            "state": "CA",
            "postal_code": "939064686",
            "telephone_number": "831-676-6457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 CONSTITUTION BLVD",
            "city": "SALINAS",
            "state": "CA",
            "postal_code": "939063100",
            "telephone_number": "831-755-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "SERGIO",
        "middle_name": "ENRIQUE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-12",
        "last_updated": "2016-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salinas, CA

Sources for this page

Verify at the official NPI Registry.