Active NPI
Jacob Rodriguez, RN
- Registered Nurse
- Baltimore, MD
National Provider Identifier
1740837921
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R239870
- Practice address
- 428 E 25TH St
Baltimore, MD 21218-5304 - Phone
- (410) 617-0142
- NPI assigned
- Aug 21, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R239870 | MD | Primary |
Addresses
Primary practice location
428 E 25TH St
Baltimore, MD 21218-5304
Mailing address
7257 Steamerbell Row
Columbia, MD 21045
Other practice location 1
15245 Shady Grove Road
Suite 130
Rockville, MD 20850
Phone (301) 527-1650
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R239870 | Other | MD | MARYLAND STATE BOARD OF NURSING |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R239870 | MD | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595980800000",
"number": "1740837921",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7257 STEAMERBELL ROW",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "21045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "428 E 25TH ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212185304",
"telephone_number": "410-617-0142"
}
],
"practiceLocations": [
{
"address_1": "15245 Shady Grove Road",
"address_2": "Suite 130",
"address_purpose": "LOCATION",
"city": "Rockville",
"state": "MD",
"postal_code": "20850",
"country_code": "US",
"telephone_number": "301-527-1650",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "JACOB",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-21",
"last_updated": "2020-07-29",
"certification_date": "2020-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MD",
"license": "R239870",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MARYLAND STATE BOARD OF NURSING",
"identifier": "R239870",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.