Cristina Mata Rodriguez, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA11311 Issued in TX

Practice address

4115 E Lancaster Ave
Fort Worth, TX 76103-3614

Phone

(817) 796-7370

NPI assigned

Aug 8, 2017

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oak Street Health of Texas PLLCGroup PAC ID 2163843038, 103 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Oak Street Health of Texas, PLLC

  • Primary Care Clinic/Center
  • Fort Worth, TX
  • NPI 1497387419
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1502150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1619492964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4449",
            "city": "MCALLEN",
            "state": "TX",
            "postal_code": "785024449",
            "telephone_number": "956-362-8460",
            "fax_number": "956-362-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 E LANCASTER AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761033614",
            "telephone_number": "817-796-7370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1950 Ephriham Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761646670",
            "country_code": "US",
            "telephone_number": "817-813-7075",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1515 S Buckner Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752171760",
            "country_code": "US",
            "telephone_number": "214-305-7065",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 E Savannah Ave Ste 7",
            "address_purpose": "LOCATION",
            "city": "McAllen",
            "state": "TX",
            "postal_code": "785031728",
            "country_code": "US",
            "telephone_number": "956-362-8460",
            "fax_number": "956-362-8455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2360 Gus Thomasson Rd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "75228",
            "country_code": "US",
            "telephone_number": "214-301-7071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "CRISTINA",
        "middle_name": "MATA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-08",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA11311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL BOARD LICENSE",
            "identifier": "PA11311",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenelly Rodriguez
• Camille Rodriguez, DPM
• Carlos Jose Rodriguez, DO
• Cesar Jr Rodriguez, CNA
• Cody Rodriguez
• Daisy Jennifer Rodriguez, LCSW
• Dana Marie Rodriguez, LPC
• Desiree Rodriguez
• Destini Faith Rodriguez, DDS
• Edson Rafael Rodriguez

• Medical Physician Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; 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.
• 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.