Individual provider Active NPI

Kassidy Rodriguez

  • Physician Assistant
  • Brandon, FL
National Provider Identifier
1548072820
Registry record updated Jul 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9119920 Issued in FL
Practice address
500 Vonderburg Dr Ste 102
Brandon, FL 33511-5968
Phone
(813) 681-5658
Fax
(813) 681-5250
NPI assigned
Jan 23, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9119920 FL Primary

Addresses

Primary practice location

500 Vonderburg Dr Ste 102
Brandon, FL 33511-5968

Mailing address

500 Vonderburg Dr Ste 102
Brandon, FL 33511-5968
Phone (813) 681-5658

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20250328001140 FL Practitioner - Physician Assistant 0749703957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2701 W Saint Isabel St
Tampa, FL 33607-6324

Hospital & facility affiliations

  • St Josephs Hospital Hospital, Tampa, FL, CCN 100075
  • Tampa General Hospital Hospital, Tampa, FL, CCN 100128

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Medical Care of Brandon LLC CurrentSince Jul 6, 2026 Accepting new patients

Locations

500 Vonderburg Dr
Ste 102
Brandon, FL 33511
Phone (813) 386-2547

4051 Upper Creek Dr
Ste 112
Sun City Center, FL 33573
Phone (813) 681-5658

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 2

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 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": "1737590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1548072820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 VONDERBURG DR STE 102",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115968",
            "telephone_number": "813-681-5658",
            "fax_number": "813-681-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 VONDERBURG DR STE 102",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115968",
            "telephone_number": "813-681-5658",
            "fax_number": "813-681-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "KASSIDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-23",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9119920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.