Alisa A Roda, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G79164 Issued in CA

Practice address

12140 New York Ranch Rd
Jackson Rancheria Health Complex
Jackson, CA 95642-9407

Phone

(209) 257-2400

Fax

(209) 257-2403

NPI assigned

Jul 22, 2005

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

Other identifiers 1

Other names 1

• Alisa A Ladringan Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Pediatrics

  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Vallejo, CA
  • NPI 1336222397

  Pediatrics

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1477553261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10305 PROMENADE PKWY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957579400",
            "telephone_number": "916-478-5000",
            "fax_number": "877-738-4262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12140 NEW YORK RANCH RD",
            "address_2": "JACKSON RANCHERIA HEALTH COMPLEX",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "956429407",
            "telephone_number": "209-257-2400",
            "fax_number": "209-257-2403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODA",
        "first_name": "ALISA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-22",
        "last_updated": "2022-01-10",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G79164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G791640",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10305 Promenade Pkwy",
            "city": "Elk Grove",
            "state": "CA",
            "country_code": "US",
            "postal_code": "957579400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ALISA",
            "last_name": "LADRINGAN",
            "middle_name": "A",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sharon Reynolds, CMT, NMT
• Baxter Key Richardson IV, MD
• Stephen Jay Riggio, DDS
• Juan C Rivera, DPT
• RMC Personal Care, LLC
• Leon Roda III, D.D.S.
• Roger Rogalski MD CHTD
• Michelle E Roland, MD
• Lisa Marie Ronback, M.D.
• Robert Francis Ross, MD

• Pediatrics Physician in Jackson, CA
• Providers in Jackson, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; 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.