Individual provider Active NPI

Luis A Rodriguez, MD

  • Pediatrics Physician
  • San Antonio, TX
National Provider Identifier
1801857560
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
J2905 Issued in TX
Practice address
1314 Guadalupe St Ste 107
San Antonio, TX 78207-5582
Phone
(210) 223-3543
Fax
(210) 924-1374
NPI assigned
Mar 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X J2905 TX Primary

Addresses

Primary practice location

1314 Guadalupe St Ste 107
San Antonio, TX 78207-5582

Mailing address

PO Box 120427
San Antonio, TX 78212-0427
Phone (210) 223-3543

Other identifiers 1

IdentifierTypeStateIssuer
096319103MedicaidTX

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190911002671 TX Practitioner - Pediatric Medicine 4486983749 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
El Centro del Barrio, Inc. CurrentSince Oct 1, 2019 Accepting new patients
El Centro del Barrio CurrentSince Oct 1, 2019 Accepting new patients
El Centro del Barrio, Inc. Current Accepting new patients
San Antonio Pediatric Assoc PA Pediatrics Past Accepting new patients
El Centro del Barrio, Inc. Past Accepting new patients
El Centro del Barrio, Inc. PastSince Dec 1, 2024 Accepting new patients

Locations

6315 S Zarzamora St
San Antonio, TX 78211
Phone (210) 924-9254

315 N San Saba
Ste 1075
San Antonio, TX 78207
Phone (210) 227-0282

3750 Commercial Ave
San Antonio, TX 78221
Phone (210) 334-3700

Interoperability endpoints

  • Direct secure messaging: luis.rodriguez.p1@direct.centromed.nextgenshare.com

Organizations & group practices 6

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": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1801857560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120427",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782120427",
            "telephone_number": "210-223-3543",
            "fax_number": "210-227-0282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 GUADALUPE ST STE 107",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782075582",
            "telephone_number": "210-223-3543",
            "fax_number": "210-924-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "LUIS",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "J2905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096319103",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.