Myrna Cruz Roderick, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

722471 Issued in TX

Practice address

6480 Delaware St
Beaumont, TX 77706-4648

Phone

(409) 813-1677

Fax

(409) 232-0596

NPI assigned

May 31, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Diagnostic Group Integrated Healthcare System, PLLCGroup PAC ID 1557506383, 34 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Diagnostic Group Integrated Healthcare System PLLC

  • Internal Medicine Physician
  • Beaumont, TX
  • NPI 1194061655

  Family

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718064000000",
    "number": "1366703852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3406 COLLEGE ST STE 200",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014612",
            "telephone_number": "409-813-1677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6480 DELAWARE ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777064648",
            "telephone_number": "409-813-1677",
            "fax_number": "409-232-0596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODERICK",
        "first_name": "MYRNA",
        "middle_name": "CRUZ",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-31",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "722471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tarasha Robinson, LCPC, CCD, ICCC
• Mandy D Roccaforte, M.S. CCC-SLP
• Jeffrey Alan Roche, PHYSICAL THERAPIST
• Edward F Rod Jr., D.D.S.
• Sean Michael Roden, D.C., B.S., CCSP
• Lynn Smith Rodgers, MS, LPC
• Grigoriy Tsotneevich Rodonaia, M.D. PA
• Ofelia Rodriguez Sierra, PTA
• Shelby Nicole Rodriguez, ATC, LAT
• Stephanie Ann Rodriguez, LCDC

• Family Nurse Practitioner in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; 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.

Verify at the official NPI Registry.