Jackie Valesca Rodriguez Bronico, M.D., MSC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

307533-01 Issued in NY

Practice address

1035 Cambridge St
Cambridge, MA 02141-1057

Phone

(617) 286-4565

NPI assigned

May 25, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Jackie Valesca Rodriguez Former name

Medicare fee-for-service enrollment

Enrolled in MA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1432512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611878400000",
    "number": "1275912164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 E NEWTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021181944",
            "telephone_number": "617-286-4565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 CAMBRIDGE ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021411057",
            "telephone_number": "617-286-4565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 N Country Rd",
            "address_purpose": "LOCATION",
            "city": "Port Jefferson",
            "state": "NY",
            "postal_code": "117772119",
            "country_code": "US",
            "telephone_number": "631-686-2549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRONICO",
        "first_name": "JACKIE",
        "middle_name": "VALESCA RODRIGUEZ",
        "name_prefix": "Dr.",
        "credential": "M.D., MSC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-25",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "TM109",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "307533-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "RODRIGUEZ",
            "middle_name": "VALESCA",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Internal Medicine Physician in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Internal Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.