NPIMap

Individual provider Active NPI

Deirdre Rodericks, M.D.

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Newton, MA
National Provider Identifier
1619330966
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
License
290185 Issued in MA
Practice address
159 Wells Ave
Newton, MA 02459-3301
Phone
(617) 243-5777
NPI assigned
Apr 4, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 267300 MA
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X 125069738 IL
Student in an Organized Health Care Education/Training Program 390200000X
Sports Medicine (Physical Medicine & Rehabilitation) Physician 2081S0010X 290185 MA Primary

Addresses

Primary practice location

159 Wells Ave
Newton, MA 02459-3301

Mailing address

300 1St Ave
Charlestown, MA 02129-3109
Phone (617) 952-5299

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220316003487 MA Practitioner - Sports MedicinePractitioner - Physical Medicine and Rehabilitation 4880989565 Reassigns benefits to 2 organizations
I20250516002592 NY Practitioner - Physical Medicine and RehabilitationPractitioner - Sports Medicine 4880989565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Sports Medicine
Education
Boston University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

17660 Union Tpke
Suite 190
Fresh Meadows, NY 11366-1538
Phone (646) 797-8471

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
303631NYMDLicensed Practical Nurse
125069738ILMDPhysical Medicine & Rehabilitation Physician
290185MAMDSports Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ny Society for the Relief of Ruptured & Crippled Maintaining Single Specialty CurrentSince May 12, 2025 Accepting new patients
Ny Society for the Relief of Ruptured & Crippled Maintaining Single Specialty CurrentSince May 12, 2025 Accepting new patients
Massachusetts General Physicians Organization Inc Single Specialty CurrentSince Dec 10, 2021 Accepting new patients
The General Hospital Corporation Single Specialty CurrentSince Dec 10, 2021 Accepting new patients

Locations

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

55 Fruit St
Boston, MA 02114

300 1st Ave
Charlestown, MA 02129
Phone (617) 952-5000

17660 Union Tpke
Ste 190
Fresh Meadows, NY 11366
Phone (718) 591-5693

429 E 75th St
New York, NY 10021
Phone (212) 265-5566

535 E 70th St
New York, NY 10021

Interoperability endpoints

  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 4

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 10

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": "1459728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1619330966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 1ST AVE",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021293109",
            "telephone_number": "617-952-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 WELLS AVE",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024593301",
            "telephone_number": "617-243-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODERICKS",
        "first_name": "DEIRDRE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-04",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "267300",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": "125069738",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "MA",
            "license": "290185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton, MA

Sources for this page

Verify at the official NPI Registry.