Active NPI
Michael J. Rodriguez, SUBMARINE IDC
- Independent Duty Corpsman
- Pearl Harbor, HI
National Provider Identifier
1275860603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- Practice address
- 822 Clark St.
NSSC Medical Suite 400
Pearl Harbor, HI 96860 - Phone
- (808) 473-3771
- Fax
- (808) 473-3109
- NPI assigned
- Nov 5, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Primary |
Addresses
Primary practice location
822 Clark St.
NSSC Medical Suite 400
Pearl Harbor, HI 96860
Mailing address
Uss Key West #Ssn722
Fpo, AP 96683-2402
Phone (808) 471-5625
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7383 | Other | IL | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257379200000",
"number": "1275860603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "USS KEY WEST #SSN722",
"city": "FPO",
"state": "AP",
"postal_code": "966832402",
"telephone_number": "808-471-5625",
"fax_number": "808-473-3109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "822 CLARK ST.",
"address_2": "NSSC MEDICAL SUITE 400",
"city": "PEARL HARBOR",
"state": "HI",
"postal_code": "96860",
"telephone_number": "808-473-3771",
"fax_number": "808-473-3109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "MICHAEL",
"middle_name": "J.",
"name_prefix": "Mr.",
"credential": "SUBMARINE IDC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-11-05",
"last_updated": "2009-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "7383",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pearl Harbor, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.