Jacqueline Roderick, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA056205 Issued in PA

Practice address

1572 Wilmington Pike
Suite 1
West Chester, PA 19382-8371

Phone

(610) 459-3278

Fax

(781) 276-6411

NPI assigned

Aug 12, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Immediate Medical Care of Pennsylvania, LP

  • Emergency Medicine Physician
  • West Chester, PA
  • NPI 1205954856
  NPD (past)

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376265600000",
    "number": "1811320054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 824301",
            "address_2": "SUITE 1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191824031",
            "telephone_number": "610-459-3278",
            "fax_number": "781-276-6411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1572 WILMINGTON PIKE",
            "address_2": "SUITE 1",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193828371",
            "telephone_number": "610-459-3278",
            "fax_number": "781-276-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODERICK",
        "first_name": "JACQUELINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-12",
        "last_updated": "2013-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA056205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa R Rocco, CCC, SLP
• Stephanie Roche
• Loretta Rochford
• Julia Rodden
• Kelly Rodden
• Maria X. Rodriguez Romo, SLP
• Justin Roe, M.D.
• Danielle Roeske
• Michael Roeske
• Mary Jane Rogan, CRNP

• Physician Assistant in West Chester, PA
• Providers in West Chester, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.