Individual provider Active NPI

Lisa Ayoub-Rodriguez, M.D.

  • Pediatrics Physician
  • El Paso, TX
National Provider Identifier
1679747935
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
43986 Issued in TX
Practice address
4801 Alberta Ave
El Paso, TX 79905-2707
Phone
(915) 545-6810
Fax
(915) 545-8859
NPI assigned
Apr 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 01069736A IN
Pediatrics Physician 208000000X 43986 TX Primary

Addresses

Primary practice location

4801 Alberta Ave
El Paso, TX 79905-2707

Mailing address

4800 Alberta Ave Ste 101
El Paso, TX 79905-2709
Phone (915) 545-6720

Other identifiers 2

IdentifierTypeStateIssuer
201023560MedicaidIN
000000717320OtherINANTHEM PROVIDER NUMBER

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121018000669 TX Practitioner - Pediatric Medicine 3375721913 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Texas Southwestern Medical School at Dallas, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Childrens Physician GroupGroup PAC ID 4385722081, 661 clinicians

Practice addresses (Care Compare)

8611 N Mopac Expy
Austin, TX 78759-8319
Phone (832) 824-1000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center El Paso CurrentSince Oct 8, 2012 Accepting new patients
Texas Children'S Physician Group Pediatrics CurrentSince Jan 2, 2024 Accepting new patients
Texas Tech University Health Sciences Center El Paso Current Accepting new patients
Texas Tech University Health Sciences Center El Paso Pediatrics CurrentSince Oct 8, 2012 Accepting new patients

Locations

8611 N Mopac Expy
Austin, TX 78759
Phone (713) 816-1250

4801 Alberta Ave
El Paso, TX 79905
Phone (915) 215-5200

4800 Alberta Ave
Ste 101
El Paso, TX 79905
Phone (915) 215-4478

1102 Bates Ave
#1450
Houston, TX 77030

6621 Fannin St
Houston, TX 77030
Phone (832) 824-1866

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.

NPI Registry JSON

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350432000000",
    "number": "1679747935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 ALBERTA AVE STE 101",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799052709",
            "telephone_number": "915-545-6720",
            "fax_number": "915-545-5755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 ALBERTA AVE",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799052707",
            "telephone_number": "915-545-6810",
            "fax_number": "915-545-8859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYOUB-RODRIGUEZ",
        "first_name": "LISA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-17",
        "last_updated": "2012-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01069736A",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "43986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201023560",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000717320",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.