Individual provider Active NPI

Segundo A Rodriguez, M.D

  • Colon & Rectal Surgery Physician
  • San Juan, PR
National Provider Identifier
1417903220
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
011740 Issued in PR
Practice address
611 Calle Pavia
Suite 110
San Juan, PR 00909-2239
Phone
(787) 727-4737
Fax
(787) 727-4714
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208C00000X 011740 PR Primary
Specialist 174400000X

Addresses

Primary practice location

611 Calle Pavia
Suite 110
San Juan, PR 00909-2239

Mailing address

611 Calle Pavia
Suite 110
San Juan, PR 00909-2239
Phone (787) 727-4737

Other names 1

  • Dr. Segundo A Rodriguez Former name

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20080904000225 PR Practitioner - Colorectal Surgery (Proctology) 7517033251 Reassigns benefits to 2 organizations
Practice locations: San Juan, PR; Santurce, PR

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
University Central del Caribe Escuela de Medicina, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1462 Calle Prof Augusto Rodriguez
San Juan, PR 00909-2145
Phone (787) 727-6060

611 Calle Mauel Pavia
Suite 110
Santurce, PR 00910-0001
Phone (787) 727-4737

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy80

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11740PRMDSocial Worker
011740PRMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Recinto de Ciencias Medicas Single Specialty CurrentSince Jul 8, 2017 Accepting new patients
Recinto de Ciencias Medicas Single Specialty CurrentSince Jul 8, 2017 Accepting new patients
Departamento de Salud Oficial Past Accepting new patients
Metro Santurce, Inc. Single Specialty Past Accepting new patients

Locations

BO Monacillos
San Juan, PR 00935

Centro Medico De
San Juan, PR 00935
Phone (781) 763-4149

BO Monacillos Centro Med
San Juan, PR 00935
Phone (787) 763-2440

BO Monacillos Centro Medico De
San Juan, PR 00935
Phone 78775825252379

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1417903220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 CALLE PAVIA",
            "address_2": "SUITE 110",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009092239",
            "telephone_number": "787-727-4737",
            "fax_number": "787-727-4714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 CALLE PAVIA",
            "address_2": "SUITE 110",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009092239",
            "telephone_number": "787-727-4737",
            "fax_number": "787-727-4714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "SEGUNDO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "PR",
            "license": "011740",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SEGUNDO",
            "last_name": "RODRIGUEZ",
            "middle_name": "A",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.