NPIMap

Organization Active NPI

Mark a Rodriguez MD, PA

  • Family Medicine Physician
  • San Antonio, TX
National Provider Identifier
1255637906
Registry record updated Feb 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
H4659 Issued in TX
Legal business name
MARK A RODRIGUEZ MD, PA
Practice address
12602 Toepperwein Rd
Suite 201
San Antonio, TX 78233
Phone
(210) 646-0404
Fax
(210) 656-7965
NPI assigned
Jan 28, 2011
Last updated
Feb 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2011

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

Authorized official

Name
Mark A Rodriguez, MDNPI 1982708111
Title
Owner/Administrator
Phone
(210) 646-0404

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X H4659 TX Primary

Addresses

Primary practice location

12602 Toepperwein Rd
Suite 201
San Antonio, TX 78233

Mailing address

12602 Toepperwein Rd
Suite 201
San Antonio, TX 78233
Phone (210) 646-0404

Other identifiers 2

IdentifierTypeStateIssuer
86691XOtherTXBCBS
4298050OtherTXAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110413000061 TX Part B Supplier - Clinic/Group Practice 5597949768 Receives reassigned benefits from 3 practitioners
Practice locations: Live Oak, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2025943Mark a Rodriguez, MD, PA12602 Toepperwein Road, Ste 201, San Antonio, TX 78233Provider-performed microscopyJun 20, 2027

National Provider Directory

National Provider Directory

Locations

11515 Toepperwein Rd
Ste 202
Live Oak, TX 78233
Phone (210) 646-0404

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ICEADD

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1296172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297036800000",
    "number": "1255637906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12602 TOEPPERWEIN RD",
            "address_2": "SUITE 201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78233",
            "telephone_number": "210-646-0404",
            "fax_number": "210-656-7965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12602 TOEPPERWEIN RD",
            "address_2": "SUITE 201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78233",
            "telephone_number": "210-646-0404",
            "fax_number": "210-656-7965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK A RODRIGUEZ MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-28",
        "last_updated": "2011-02-07",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "210-646-0404",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H4659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "86691X",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4298050",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.