NPIMap

Individual provider Active NPI

Jose Luis Rodriguez, MD

  • Neurological Surgery Physician
  • Pomona, CA
National Provider Identifier
1235115072
Registry record updated Jun 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
G49547 Issued in CA
Practice address
255 E Bonita Ave
Building #9
Pomona, CA 91767-1923
Phone
(909) 450-0369
Fax
(909) 450-0366
NPI assigned
Dec 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X G49547 CA Primary

Addresses

Primary practice location

255 E Bonita Ave
Building #9
Pomona, CA 91767-1923

Mailing address

255 E Bonita Ave
Building #9
Pomona, CA 91767-1923
Phone (909) 450-0369

Other identifiers 1

IdentifierTypeStateIssuer
GR0099730MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040708001202 CA Practitioner - Neurosurgery 7113905993 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of California, Irvine, California College of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

255 E Bonita Ave
BLDG 9
Pomona, CA 91767-1923
Phone 9094500369213

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion16
Laminectomy or laminotomy (partial removal of spine bones)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G49547CAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Casa Colina Hospital and Centers for Healthcare Current Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Emanate Health Foothill Presbyterian Hospital Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Yong Luke Lee Medical Corporation Past Accepting new patients
Primecare Medical Group Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Redlands Community Hospital Past Accepting new patients

Locations

255 E Bonita Ave
Ste 9
Pomona, CA 91767

255 E Bonita Ave
Bldg 9
Pomona, CA 91767
Phone (909) 450-0369

255 E Bonita Ave
Pomona, CA 91767
Phone (866) 724-4127

255 E Bonita Ave
Bldg NO9
Pomona, CA 91767

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: casacolina@direct.casacolina.org

Organizations & group practices 11

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 2

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": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276560000000",
    "number": "1235115072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 E BONITA AVE",
            "address_2": "BUILDING #9",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671923",
            "telephone_number": "909-450-0369",
            "fax_number": "909-450-0366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E BONITA AVE",
            "address_2": "BUILDING #9",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671923",
            "telephone_number": "909-450-0369",
            "fax_number": "909-450-0366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "JOSE",
        "middle_name": "LUIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2010-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "G49547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0099730",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.