Jeff R. Roderick, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

8537 Issued in AZ

Practice address

4864 E Baseline Rd Ste 105
Mesa, AZ 85206-4629

Phone

(480) 558-1900

Fax

(480) 633-6058

NPI assigned

Jul 18, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

ChiropracticAlso: Sports Medicine

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

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.

• Pro Active Chiropractic and Sports Medicine PLLC

  • Clinic/Center
  • Mesa, AZ
  • NPI 1669233763
  NPD Authorized official

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586995200000",
    "number": "1740289248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4864 E BASELINE RD STE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064629",
            "telephone_number": "480-558-1900",
            "fax_number": "480-633-6058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4864 E BASELINE RD STE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064629",
            "telephone_number": "480-558-1900",
            "fax_number": "480-633-6058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODERICK",
        "first_name": "JEFF",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-18",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "ID",
            "license": "CHIA-872",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "8537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "C8729",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010025346",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M8059948",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald Leroy Rock, DDS
• Kristina E Rocker
• Rocky Mountain Holdings, LLC
• Cesar M Rodarte, D.O
• Dana Lynn Rodenbostel, PT, DPT
• Sahar Rodfar, DDS
• Paige Rodgers, RBT
• Rodney J. Palmer DDS, PLC
• Rodney S Iancovici MD PC
• Patricia Rodrigues, RN, LPC

• Chiropractor in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.