Individual provider Active NPI

Luis Felipe Rodriguez, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Portland, OR
National Provider Identifier
1497757447
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
MD26869 Issued in OR
Practice address
13007 NE Glisan St
Portland, OR 97230-2545
Phone
(503) 215-7866
Fax
(503) 215-7864
NPI assigned
Aug 10, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD26869 OR Primary

Addresses

Primary practice location

13007 NE Glisan St
Portland, OR 97230-2545

Mailing address

13007 NE Glisan St
Portland, OR 97230-2545
Phone (503) 215-7866

Other identifiers 1

IdentifierTypeStateIssuer
11604802MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lrodriguez189270@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20150429000932 OR Order and Referring Only - Geriatric MedicinePractitioner - Hospice/Palliative CarePractitioner - Geriatric Medicine 3072576255

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1497757447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13007 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302545",
            "telephone_number": "503-215-7866",
            "fax_number": "503-215-7864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13007 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302545",
            "telephone_number": "503-215-7866",
            "fax_number": "503-215-7864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "LUIS",
        "middle_name": "FELIPE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OR",
            "license": "MD26869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11604802",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lrodriguez189270@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "13007 NE Glisan St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972302545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.