Individual provider Active NPI

Ivelca Rodriguez, AUD

  • Audiologist
  • North Bergen, NJ
National Provider Identifier
1336980390
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
41YA00130100 Issued in NJ
Practice address
8901 Kennedy Blvd Ste 4S
North Bergen, NJ 07047-5345
Phone
(201) 472-8500
Fax
(201) 472-8501
NPI assigned
Jun 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 41YA00130100 NJ Primary

Addresses

Primary practice location

8901 Kennedy Blvd Ste 4S
North Bergen, NJ 07047-5345

Mailing address

8901 Kennedy Blvd Ste 4S
North Bergen, NJ 07047-5345
Phone (201) 472-8500

Other practice location 1

36 Newark Ave Ste 130
Belleville, NJ 07109-4120
Phone (973) 528-2690

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240723000108 NJ Practitioner - Qualified Audiologist 6002352440 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
NJ Audiology Group IncGroup PAC ID 2769865476, 3 clinicians

Practice addresses (Care Compare)

8901 Kennedy Blvd
Suite 4S
North Bergen, NJ 07047-5345
Phone (201) 472-8500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
41YA00130100NJMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
NJ Audiology Group Inc CurrentSince Jul 8, 2024 Accepting new patients
NJ Audiology Group Inc Past Accepting new patients

Locations

8901 Kennedy Blvd
Ste 4S
North Bergen, NJ 07047
Phone (201) 374-1718

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.

NPI Registry JSON

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1336980390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8901 KENNEDY BLVD STE 4S",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070475345",
            "telephone_number": "201-472-8500",
            "fax_number": "201-472-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8901 KENNEDY BLVD STE 4S",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070475345",
            "telephone_number": "201-472-8500",
            "fax_number": "201-472-8501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36 Newark Ave Ste 130",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "NJ",
            "postal_code": "071094120",
            "country_code": "US",
            "telephone_number": "973-528-2690",
            "fax_number": "973-302-4074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "IVELCA",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NJ",
            "license": "41YA00130100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Bergen, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.