NPIMap

Organization Active NPI

George L. Rodriguez, M.D., P.C.

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1487871489
Registry record updated Jun 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
GEORGE L. RODRIGUEZ, M.D., P.C.
Practice address
2487 Grant Avenue
Philadelphia, PA 19114
Phone
(215) 464-0150
NPI assigned
Apr 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2009

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

Authorized official

Name
Ellen C. Bamba
Title
Administrative Director
Phone
(215) 425-1500

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X Primary

Addresses

Primary practice location

2487 Grant Avenue
Philadelphia, PA 19114

Mailing address

2487 Grant Avenue
Philadelphia, PA 19114
Phone (215) 464-0150

Other identifiers 2

IdentifierTypeStateIssuer
045575900OtherPAINDEPENDENCE BLUE CROSS/PERSONAL CHOICE
626086OtherPAHIGHMARK BLUE SHIELD

Other names 1

  • University Dynamic MRI Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040714000406 PA Part B Supplier - Clinic/Group Practice 7517946643 Receives reassigned benefits from 9 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brookhaven, PA; Wyncote, PA; Woodlyn, PA; Trevose, PA; Philadelphia, PA; Malvern, PA; Bala Cynwyd, PA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
George L Rodriguez MD PC28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Locations

2487 Grant Ave
Philadelphia, PA 19114
Phone (215) 462-0150

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245715200000",
    "number": "1487871489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2487 GRANT AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19114",
            "telephone_number": "215-464-0150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2487 GRANT AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19114",
            "telephone_number": "215-464-0150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE L. RODRIGUEZ, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2009-06-23",
        "status": "A",
        "authorized_official_last_name": "BAMBA",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "215-425-1500"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS/PERSONAL CHOICE",
            "identifier": "045575900",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "626086",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Dynamic MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.