Individual provider Active NPI

Elio Jose Rodriguez Hernandez, MD

  • Student in an Organized Health Care Education/Training Program
  • Philadelphia, PA
National Provider Identifier
1255176392
Registry record updated Jun 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
MT230833 Issued in PA
Practice address
5501 Old York Rd Ste 1
Philadelphia, PA 19141-3098
Phone
(215) 456-6500
NPI assigned
Jun 29, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MT230833 PA Primary

Addresses

Primary practice location

5501 Old York Rd Ste 1
Philadelphia, PA 19141-3098

Mailing address

5501 Old York Rd Ste 1
Philadelphia, PA 19141-3098
Phone (215) 456-6500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20240715004229 PA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 7012452956

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT230833PAMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1719619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719619200000",
    "number": "1255176392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD STE 1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413098",
            "telephone_number": "215-456-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD STE 1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413098",
            "telephone_number": "215-456-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ HERNANDEZ",
        "first_name": "ELIO",
        "middle_name": "JOSE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-29",
        "last_updated": "2024-06-29",
        "certification_date": "2024-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT230833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.