Active NPI
Roderick Yumol Ballelos, DO
- Emergency Medicine Physician
- Carmichael, CA
National Provider Identifier
1336265164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 20A 10818
- Practice address
- 6501 Coyle Ave
Carmichael, CA 95608-0306 - Phone
- (562) 230-4763
- NPI assigned
- Mar 22, 2007
- 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 20A 10818 | CA | Primary |
Addresses
Primary practice location
6501 Coyle Ave
Carmichael, CA 95608-0306
Mailing address
6501 Coyle Ave
Carmichael, CA 95608-0306
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20A 10818 | Other | CA | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
620 Shadow LN
Las Vegas, NV 89106-4119
Phone (954) 939-5000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A 10818 | CA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shadow Emergency Physicians PLLC | Emergency Medicine | Current | Accepting new patients |
| Shadow Emergency Physicians PLLC | Emergency Medicine | Current | Accepting new patients |
Locations
620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Las Vegas, NV
- NPI 1184795874
-
- Emergency Medicine Physician
- Las Vegas, NV
- NPI 1043030919
Hospital & facility affiliations 12
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Henderson, NV
- NPI 1003281452
-
- General Acute Care Hospital
- Las Vegas, NV
- NPI 1346230323
-
- General Acute Care Hospital
- Las Vegas, NV
- NPI 1982289690
-
- General Acute Care Hospital
- Las Vegas, NV
- NPI 1831189638
-
- Emergency Care Clinic/Center
- Las Vegas, NV
- NPI 1861234619
Hospital
-
- General Acute Care Hospital
- Las Vegas, NV
- NPI 1417947490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1336265164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6501 COYLE AVE",
"city": "CARMICHAEL",
"state": "CA",
"postal_code": "956080306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6501 COYLE AVE",
"city": "CARMICHAEL",
"state": "CA",
"postal_code": "956080306",
"telephone_number": "562-230-4763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLELOS",
"first_name": "RODERICK",
"middle_name": "YUMOL",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CA",
"license": "20A 10818",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "20A 10818",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carmichael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
- 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.