Individual provider Active NPI

Daniela Maria Rodriguez

  • Plastic Surgery Physician
  • Saint Clair Shores, MI
National Provider Identifier
1215939673
Registry record updated Nov 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
4301080695 Issued in MI
Practice address
21727 Mack Ave
Saint Clair Shores, MI 48080-2418
Phone
(586) 777-7260
Fax
(586) 777-7265
NPI assigned
Aug 15, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 23, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 4301080695 MI Primary

Addresses

Primary practice location

21727 Mack Ave
Saint Clair Shores, MI 48080-2418

Mailing address

21727 Mack Ave
Saint Clair Shores, MI 48080-2418
Phone (586) 777-7260

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20051014000111 MI Practitioner - Plastic and Reconstructive Surgery 5698790012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Chicago College of Medicine and Surgery, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

21727 Greater Mack Ave
Saint Clair Shores, MI 48080-2418
Phone (586) 777-7260

22101 Moross Rd
Detroit, MI 48236-2148
Phone (313) 343-4000

468 Cadieux Rd
Grosse Pointe, MI 48230-1507
Phone (313) 473-1000

Hospital & facility affiliations

  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301080695MIMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Daniela Rodriguez MD PLC Plastic Surgery CurrentSince Oct 1, 2005 Accepting new patients
Renaissance Plastic Surgery P.C. PastSince Dec 1, 2015 Accepting new patients

Locations

21727 Mack Ave
St Clr Shores, MI 48080
Phone (586) 777-7260

Interoperability endpoints

  • Direct secure messaging: drodriguez1149401@direct.hfhs.org

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 and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258934400000",
    "number": "1215939673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21727 MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802418",
            "telephone_number": "586-777-7260",
            "fax_number": "586-777-7265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21727 MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802418",
            "telephone_number": "586-777-7260",
            "fax_number": "586-777-7265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "DANIELA",
        "middle_name": "MARIA",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-15",
        "last_updated": "2009-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MI",
            "license": "4301080695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.