NPIMap

Organization Active NPI

Rodriguez MD, LLC

Doing business as Rodriguez MD

  • Family Medicine Physician
  • Lawrenceville, GA
National Provider Identifier
1568778306
Registry record updated Oct 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RODRIGUEZ MD, LLC
Doing business as
Rodriguez MD
Practice address
771 Old Norcross Rd
Terrace Park Medical Center; Suite 120
Lawrenceville, GA 30046-4386
Phone
(770) 670-6920
Fax
(770) 670-6927
NPI assigned
Aug 30, 2010
Last updated
Oct 14, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2015

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

Authorized official

Name
Mr. Neville Street
Title
Manager
Phone
(650) 888-2848

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

771 Old Norcross Rd
Terrace Park Medical Center; Suite 120
Lawrenceville, GA 30046-4386

Mailing address

771 Old Norcross Rd
Terrace Park Medical Center; Suite 120
Lawrenceville, GA 30046-4386
Phone (770) 670-6920

Other identifiers 1

IdentifierTypeStateIssuer
003105719AMedicaidGA

Other names 1

  • Rodriguez MD Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101027000709 GA Part B Supplier - Clinic/Group Practice 4981898640 Receives reassigned benefits from 9 practitioners
Practice locations: Lawrenceville, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2014967Rodriguez MD771 Old Norcross Road, Suite 120, Lawrenceville, GA 30046Certificate of waiverOct 19, 2026

National Provider Directory

National Provider Directory

Locations

771 Old Norcross Rd
Ste 120
Lawrenceville, GA 30046
Phone (770) 670-6920

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444780800000",
    "number": "1568778306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 OLD NORCROSS RD",
            "address_2": "TERRACE PARK MEDICAL CENTER; SUITE 120",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464386",
            "telephone_number": "770-670-6920",
            "fax_number": "770-670-6927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 OLD NORCROSS RD",
            "address_2": "TERRACE PARK MEDICAL CENTER; SUITE 120",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464386",
            "telephone_number": "770-670-6920",
            "fax_number": "770-670-6927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RODRIGUEZ MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-30",
        "last_updated": "2015-10-14",
        "status": "A",
        "authorized_official_last_name": "STREET",
        "authorized_official_first_name": "NEVILLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "650-888-2848",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003105719A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rodriguez MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.