Individual provider Active NPI

Kenneth Eduardo Rodriguez

  • Physician Assistant
  • Newport Beach, CA
National Provider Identifier
1710854328
Registry record updated Mar 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
67529 Issued in CA
Practice address
22 Corporate Plaza Dr
Newport Beach, CA 92660-7985
Phone
(949) 722-7038
Fax
(949) 630-4900
NPI assigned
Oct 20, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 67529 CA Primary

Addresses

Primary practice location

22 Corporate Plaza Dr
Newport Beach, CA 92660-7985

Mailing address

31892 La Subida Dr
Trabuco Canyon, CA 92679-3405
Phone (949) 257-8524

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20260312001584 CA Practitioner - Physician Assistant 1355824814 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

22 Corporate Plaza Dr
Newport Beach, CA 92660-7985
Phone (949) 722-7038

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
67529CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
NPI 1972355329 CurrentSince Feb 1, 2026 Accepting new patients
Orthopedic Institute of Newport Beach Limited Partnership CurrentSince Feb 1, 2026 Accepting new patients
Newport Orthopedic Institute Past Accepting new patients

Locations

22 Corporate Plaza Dr
Newport Beach, CA 92660
Phone (949) 472-2703

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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 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": "1760918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773360000000",
    "number": "1710854328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31892 LA SUBIDA DR",
            "city": "TRABUCO CANYON",
            "state": "CA",
            "postal_code": "926793405",
            "telephone_number": "949-257-8524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 CORPORATE PLAZA DR",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607985",
            "telephone_number": "949-722-7038",
            "fax_number": "949-630-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "KENNETH",
        "middle_name": "EDUARDO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-10-20",
        "last_updated": "2026-03-13",
        "certification_date": "2026-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "67529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.