Individual provider Active NPI

Edward Luis Rodriguez, M.D.

  • Psychiatry Physician
  • Jackson, MI
National Provider Identifier
1477579266
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4301070959 Issued in MI
Practice address
300 W Washington Ave Ste 210B
Jackson, MI 49201-2160
Phone
(517) 344-0913
Fax
(517) 905-6007
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 4301070959 MI Primary

Addresses

Primary practice location

300 W Washington Ave Ste 210B
Jackson, MI 49201-2160

Mailing address

3500 N Elm Ave
Opmh
Jackson, MI 49201-8887
Phone (517) 780-5254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20160801002499 MI Practitioner - Psychiatry 5496048266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Irwin Counseling Service PLLCGroup PAC ID 3971975004, 10 clinicians

Practice addresses (Care Compare)

300 W Washington Ave
Suite 210B
Jackson, MI 49201-2160
Phone (517) 227-6038

Hospital & facility affiliations

  • Henry Ford Allegiance Health Hospital, Jackson, MI, CCN 230092

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301070959MIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Irwin Counseling Service PLLC CurrentSince Feb 14, 2023 Accepting new patients

Locations

321 S Main St
Rm 217
Ann Arbor, MI 48104

300 W Washington Ave
Ste 210B
Jackson, MI 49201
Phone (517) 227-6038

Organizations & group practices 1

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 1

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1477579266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 N ELM AVE",
            "address_2": "OPMH",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492018887",
            "telephone_number": "517-780-5254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W WASHINGTON AVE STE 210B",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012160",
            "telephone_number": "517-344-0913",
            "fax_number": "517-905-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "EDWARD",
        "middle_name": "LUIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301070959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.