Individual provider Active NPI

Nichole Rodriguez, PA

  • Physician Assistant
  • Del Rio, TX
National Provider Identifier
1790760486
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA03627 Issued in TX
Practice address
1011 E 7TH St
Del Rio, TX 78840-4162
Phone
(830) 775-8513
Fax
(830) 774-1430
NPI assigned
Dec 14, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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 PA03627 TX Primary

Addresses

Primary practice location

1011 E 7TH St
Del Rio, TX 78840-4162

Mailing address

300 Silver Sage Dr
Del Rio, TX 78840-2150
Phone (830) 719-3271

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20111025000576 TX Practitioner - Physician Assistant 8224201942 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gutierrez MD PLLCGroup PAC ID 9032367024, 2 clinicians

Practice addresses (Care Compare)

612 N Bedell Ave
Suite a
Del Rio, TX 78840-4173
Phone (830) 775-1166

Hospital & facility affiliations

  • Val Verde Regional Medical Center Hospital, Del Rio, TX, CCN 450154

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA03627TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Uvalde Bone & Joint Clinic P.a. Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GHGIBD/Endpoint/GHGIBD
  • FHIR API: https://fhir4.healow.com/fhir/r4/BFEEAD/Endpoint/BFEEAD

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 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": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1790760486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SILVER SAGE DR",
            "city": "DEL RIO",
            "state": "TX",
            "postal_code": "788402150",
            "telephone_number": "830-719-3271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 E 7TH ST",
            "city": "DEL RIO",
            "state": "TX",
            "postal_code": "788404162",
            "telephone_number": "830-775-8513",
            "fax_number": "830-774-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "NICHOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-14",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Del Rio, TX

Sources for this page

Verify at the official NPI Registry.