Active NPI
Elizabeth Roderick, APRN-BC
- Family Nurse Practitioner
- Saint Joseph, MO
National Provider Identifier
1801099874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 138383
- Practice address
- 5301 Faraon St Ste 220
Saint Joseph, MO 64506-3800 - Phone
- (816) 271-8131
- Fax
- (816) 271-8132
- NPI assigned
- Jun 7, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 138383 | MO | |
| Family Nurse Practitioner | 363LF0000X | 138383 | MO | Primary |
Addresses
Primary practice location
5301 Faraon St Ste 220
Saint Joseph, MO 64506-3800
Mailing address
5301 Faraon St Ste 220
Saint Joseph, MO 64506-3800
Phone (816) 271-8131
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200672230A | Medicaid | KS | |
| 428451702 | Medicaid | MO | |
| 1801099874 | Medicaid | MO |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 138383 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Joseph Oncology Inc | Past | Accepting new patients |
Interoperability endpoints
- elizabeth.roderick@direct.mymlc.com
Organizations & group practices 1
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.
-
- Hematology & Oncology Physician
- St Joseph, MO
- NPI 1356300735
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305504000000",
"number": "1801099874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5301 FARAON ST STE 220",
"city": "SAINT JOSEPH",
"state": "MO",
"postal_code": "645063800",
"telephone_number": "816-271-8131",
"fax_number": "816-271-8132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5301 FARAON ST STE 220",
"city": "SAINT JOSEPH",
"state": "MO",
"postal_code": "645063800",
"telephone_number": "816-271-8131",
"fax_number": "816-271-8132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODERICK",
"first_name": "ELIZABETH",
"name_prefix": "Mrs.",
"credential": "APRN-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-07",
"last_updated": "2011-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MO",
"license": "138383",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "138383",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200672230A",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "428451702",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1801099874",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Joseph, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.