Individual provider Active NPI

Marsha Alexandra Rodriguez, APRN

  • Family Nurse Practitioner
  • Roanoke, IL
National Provider Identifier
1639890965
Registry record updated Sep 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209025893 Issued in IL
Practice address
401 N Main St
Roanoke, IL 61561-7585
Phone
(309) 923-2661
NPI assigned
Sep 6, 2022
Last updated
Sep 11, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209025893 IL Primary

Addresses

Primary practice location

401 N Main St
Roanoke, IL 61561-7585

Mailing address

401 N Main St
Roanoke, IL 61561-7585
Phone (309) 923-2661

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20221004002588 IL Practitioner - Nurse Practitioner 7719363431 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Swedishamerican HospitalGroup PAC ID 5799698346, 386 clinicians

Practice addresses (Care Compare)

1340 Charles St
Suite 404
Rockford, IL 61104-2200
Phone (779) 696-1890

Hospital & facility affiliations

  • Uw Health Hospital, Rockford, IL, CCN 140228

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209025893ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital CurrentSince Sep 7, 2023 Accepting new patients
Swedishamerican Hospital CurrentSince Sep 7, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Oct 1, 2022 Accepting new patients
Swedishamerican Hospital Current Accepting new patients

Locations

1404 Washington St
Mendota, IL 61342
Phone (815) 538-1825

1405 E 12th St
Ste 600
Mendota, IL 61342
Phone (815) 538-7200

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1340 Charles St
Ste 404
Rockford, IL 61104
Phone (815) 229-2300

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1662422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662854400000",
    "number": "1639890965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N MAIN ST",
            "city": "ROANOKE",
            "state": "IL",
            "postal_code": "615617585",
            "telephone_number": "309-923-2661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N MAIN ST",
            "city": "ROANOKE",
            "state": "IL",
            "postal_code": "615617585",
            "telephone_number": "309-923-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "MARSHA",
        "middle_name": "ALEXANDRA",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-11",
        "certification_date": "2022-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209025893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, IL

Sources for this page

Verify at the official NPI Registry.