Individual provider Active NPI

Luis Wilfredo Lopez-Rodriguez, PLP

  • Psychologist
  • Arcadia, FL
National Provider Identifier
1619502846
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
725 N 12TH Ave BLDG B
Arcadia, FL 34266-8752
Phone
(417) 761-5000
NPI assigned
Mar 9, 2020
Last updated
Feb 17, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2020030184 MO
Clinical Psychologist 103TC0700X PY11347 FL
Psychologist 103T00000X Primary

Addresses

Primary practice location

725 N 12TH Ave BLDG B
Arcadia, FL 34266-8752

Mailing address

101 Riverfront Blvd Ste 710
Bradenton, FL 34205-8812
Phone (941) 776-4000

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221013000609 FL Practitioner - Clinical Psychologist 9830565068 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PY11347FLMDClinical Psychologist
2020030184MOMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
MCR Health, Inc. CurrentSince Jan 19, 2023 Accepting new patients
Rapha Family Centre LLC CurrentSince Nov 14, 2022 Accepting new patients
MCR Health, Inc. CurrentSince Jan 19, 2023 Accepting new patients

Locations

725 N 12th Ave
Bldg B
Arcadia, FL 34266
Phone (863) 494-1242

101 Riverfront Blvd
Ste 710
Bradenton, FL 34205

2008 N Goldenrod Rd
Bldg 300
Orlando, FL 32807
Phone (321) 440-7193

12271 US Highway 301 N
Parrish, FL 34219
Phone (941) 713-2231

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676592000000",
    "number": "1619502846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 RIVERFRONT BLVD STE 710",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342058812",
            "telephone_number": "941-776-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 N 12TH AVE BLDG B",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342668752",
            "telephone_number": "417-761-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ-RODRIGUEZ",
        "first_name": "LUIS",
        "middle_name": "WILFREDO",
        "credential": "PLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-09",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2020030184",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY11347",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arcadia, FL

Sources for this page

Verify at the official NPI Registry.