Natasha Victoria Rodriguez Mancebo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085007443 Issued in IL

Practice address

711 W John Gwynn Ave
Peoria, IL 61605-2270

Phone

(309) 680-7600

Fax

(309) 671-2188

NPI assigned

Dec 2, 2019

Last updated

Dec 2, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: natasha.rodriguez.1@11903.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Esperanza Health Centers

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1124187125
  Medicare reassignment
• Esperanza Health Centers

  dba Esperanza at Cultivate Collective

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1265114623
  NPD (past)
• Esperanza Health Centers

  dba Daley College Shelter

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1316793813
  NPD (past)
• Esperanza Health Centers

  dba Esperanza Little Village

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1477812030
  NPD (past)

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

{
    "created_epoch": "1575244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575244800000",
    "number": "1588201115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043221",
            "telephone_number": "309-680-7669",
            "fax_number": "309-681-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W JOHN GWYNN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052270",
            "telephone_number": "309-680-7600",
            "fax_number": "309-671-2188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ MANCEBO",
        "first_name": "NATASHA",
        "middle_name": "VICTORIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-02",
        "last_updated": "2019-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085007443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Rockhold, APN
• Caitlin Connie Rodeghier, DO
• David Rodenberg
• Courtney Rodich, APN, ACNS-BC
• Rubi Caresse Rodriguez Bobadilla, MD
• Ashley Rodriguez
• Nydia I Rodriguez
• Carrie Joanne Roe-Fitzgerald, FNP
• Allison Roe, DO
• Laura M Roe, M.D.

• Physician Assistant in Peoria, IL
• Providers in Peoria, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.