Individual provider Active NPI

Mayra Lizbeth Rodriguez, NP-C

  • Family Nurse Practitioner
  • Dakota Dunes, SD
National Provider Identifier
1720807803
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A181632 Issued in IA
Practice address
575 N Sioux Point Rd
Dakota Dunes, SD 57049-5312
Phone
(605) 217-2667
Fax
(605) 217-2900
NPI assigned
Oct 7, 2024
Last updated
Oct 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

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 A181632 IA Primary

Addresses

Primary practice location

575 N Sioux Point Rd
Dakota Dunes, SD 57049-5312

Mailing address

575 N Sioux Point Rd
Dakota Dunes, SD 57049-5312
Phone (605) 217-2667

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, IA, NE3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20241112004175 SD Practitioner - Nurse Practitioner 8527592633 Reassigns benefits to 1 organization
I20241115002207 IA Practitioner - Nurse Practitioner 8527592633 Reassigns benefits to 1 organization
I20250422002077 NE Practitioner - Nurse Practitioner 8527592633 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cnos PCGroup PAC ID 4284548942, 98 clinicians

Practice addresses (Care Compare)

201 E 4TH St
South Sioux City, NE 68776-9916
Phone (605) 217-2667

5708 Sunnybrook CT
Sioux City, IA 51106-4254
Phone (605) 217-2667

575 N Sioux Point Rd
Dakota Dunes, SD 57049-5312
Phone (605) 217-2667

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A181632IAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Cnos, PC CurrentSince Oct 21, 2024 Accepting new patients
Cnos PC CurrentSince Oct 21, 2024 Accepting new patients

Locations

2735 Outer Dr N
Sioux City, IA 51104
Phone (712) 224-5692

5708 Sunnybrook Ct
Sioux City, IA 51106

201 E 4th St
South Sioux City, NE 68776
Phone (402) 412-2160

1200 Providence Rd
Wayne, NE 68787
Phone (402) 375-3800

575 N Sioux Point Rd
North Sioux City, SD 57049
Phone (605) 217-2615

Interoperability endpoints

  • Direct secure messaging: mayrarodriguez@cnos.allscriptsdirect.net
  • Direct secure messaging: mrodriquez1153074@direct.unitypoint.org

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.

Hospital & facility affiliations 6

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": "1728259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1720807803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 N SIOUX POINT RD",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "570495312",
            "telephone_number": "605-217-2667",
            "fax_number": "605-217-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 N SIOUX POINT RD",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "570495312",
            "telephone_number": "605-217-2667",
            "fax_number": "605-217-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "MAYRA",
        "middle_name": "LIZBETH",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-07",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A181632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dakota Dunes, SD

Sources for this page

Verify at the official NPI Registry.