Individual provider Active NPI

Ruben Benjamin Delarosa, PA-C

  • Surgical Physician Assistant
  • Tyler, TX
National Provider Identifier
1427447580
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA09626 Issued in TX
Practice address
3414 Golden Rd
Tyler, TX 75701-8336
Phone
(903) 939-7500
NPI assigned
Jan 13, 2015
Last updated
Feb 15, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA09626 TX
Surgical Physician Assistant 363AS0400X PA09626 TX Primary

Addresses

Primary practice location

3414 Golden Rd
Tyler, TX 75701-8336

Mailing address

3414 Golden Rd
Tyler, TX 75701-8336
Phone (903) 939-7500

Other practice location 1

2211 S Loop 256
Palestine, TX 75801-4701
Phone (903) 939-7500

Other practice location 2

925 W Loop 281
Longview, TX 75604-2918
Phone (903) 939-7500

Other practice location 3

1123 S Palestine St Ste 100
Athens, TX 75751-3645
Phone (903) 939-7500

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150511000758 TX Practitioner - Physician Assistant 0749509917 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ortholonestar PLLCGroup PAC ID 9931529062, 416 clinicians

Practice addresses (Care Compare)

3414 Golden Rd
Tyler, TX 75701-8336
Phone (903) 939-7500

3800 Gaylord Pkwy
Suite 710
Frisco, TX 75034-9635
Phone (214) 220-2468

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA09626TXMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ortholonestar, PLLC CurrentSince Jan 30, 2023 Accepting new patients
Charles R Gordon MD PA CurrentSince Oct 22, 2018 Accepting new patients
Ortholonestar, PLLC CurrentSince Jan 30, 2023 Accepting new patients
Charles R Gordon MD PA Physician Assistant CurrentSince Oct 22, 2018 Accepting new patients

Locations

1123 S Palestine St
Ste 100
Athens, TX 75751
Phone (903) 675-5300

4700 Seton Center Pkwy
Ste 115
Austin, TX 78759
Phone (346) 440-0644

3800 Gaylord Pkwy
Ste 710
Frisco, TX 75034

925 W Loop 281
Longview, TX 75604
Phone (430) 240-6029

2211 S Loop 256
Palestine, TX 75801
Phone (903) 581-1601

3414 Golden Rd
Tyler, TX 75701
Phone (903) 590-3050

Interoperability endpoints

  • Direct secure messaging: rdelarosa355123@ahs.direct-ci.com
  • Direct secure messaging: ruben.de.la.rosa.1@15533.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1421107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1427447580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3414 GOLDEN RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018336",
            "telephone_number": "903-939-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3414 GOLDEN RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018336",
            "telephone_number": "903-939-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2211 S Loop 256",
            "address_purpose": "LOCATION",
            "city": "Palestine",
            "state": "TX",
            "postal_code": "758014701",
            "country_code": "US",
            "telephone_number": "903-939-7500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "925 W Loop 281",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756042918",
            "country_code": "US",
            "telephone_number": "903-939-7500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1123 S Palestine St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "TX",
            "postal_code": "757513645",
            "country_code": "US",
            "telephone_number": "903-939-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DELAROSA",
        "first_name": "RUBEN",
        "middle_name": "BENJAMIN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-13",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09626",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA09626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.