Roderick Mathis

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13831 Issued in FL

Practice address

13275 W Colonial Dr
Suite 200
Winter Garden, FL 34787-3984

Phone

(407) 905-8827

Fax

(407) 654-4528

NPI assigned

Feb 1, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• Freedom Health HMO Network

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395792000000",
    "number": "1396882833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S WOODLAND ST",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873546",
            "telephone_number": "407-905-8827",
            "fax_number": "407-654-4528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13275 W COLONIAL DR",
            "address_2": "SUITE 200",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873984",
            "telephone_number": "407-905-8827",
            "fax_number": "407-654-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "RODERICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2014-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "13831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004389000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Flavia Moraes Marzullo
• Makayla Maelyn Massey
• Stefania Massi, RMHCI
• Katrina N Mastrola
• Courtney Racquel Mathis, MSN, ARNP, WHNP-BC
• Ruth Esther Matos, MD
• Victor W Matthews, M.D.
• Maureen Sawh, OD, PLC
• Lovell Leonard Mayle, MD
• Mischelle Ann Mbonu

• General Practice Dentistry in Winter Garden, FL
• Providers in Winter Garden, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; 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.