Individual provider Active NPI

Eddie Gabriel Rodriguez, M.D.

  • Pediatric Emergency Medicine (Emergency Medicine) Physician
  • Ponce, PR
National Provider Identifier
1740629922
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Emergency Medicine) PhysicianTaxonomy code 207PP0204X
License
288283 Issued in NY
Practice address
917 Ave Tito Castro
Ponce, PR 00716-4717
Phone
(787) 844-2080
NPI assigned
Jun 20, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X 288283 NY Primary

Addresses

Primary practice location

917 Ave Tito Castro
Ponce, PR 00716-4717

Mailing address

1511 Ave Ponce de Leon Apt 1153
San Juan, PR 00909-5001
Phone (787) 365-9599

Other practice location 1

506 6th St
Brooklyn, NY 11215-3609
Phone (718) 780-5025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20171018002622 NY Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 7214203207 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Suny Health Science Center at Bklyn CurrentSince Jul 1, 2018 Accepting new patients
State of New York Comptrollers Office CurrentSince Jul 1, 2018 Accepting new patients

Locations

470 Clarkson Ave
Brooklyn, NY 11203
Phone (718) 421-1003

Interoperability endpoints

  • Direct secure messaging: erodriguez1055750@nychhc.direct-ci.com
  • Direct secure messaging: eddie.rodriguez@54618109378564.direct.elationemr.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1740629922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 AVE PONCE DE LEON APT 1153",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009095001",
            "telephone_number": "787-365-9599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 AVE TITO CASTRO",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007164717",
            "telephone_number": "787-844-2080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "506 6th St",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112153609",
            "country_code": "US",
            "telephone_number": "718-780-5025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "EDDIE",
        "middle_name": "GABRIEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-20",
        "last_updated": "2025-09-11",
        "certification_date": "2020-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "NY",
            "license": "288283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

Verify at the official NPI Registry.