Active NPI
Luis Ramon Rodriguez, MD
- Pediatrics Physician
- Brooklyn, NY
National Provider Identifier
1811921349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 177629
- Practice address
- 760 Broadway, Woodhull Medical & Mental Health Center
Department of Pediatrics
Brooklyn, NY 11206 - Phone
- (718) 963-8000
- Fax
- (718) 630-3122
- NPI assigned
- Jul 10, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 177629 | NY | Primary |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | 177629 | NY |
Addresses
Primary practice location
760 Broadway, Woodhull Medical & Mental Health Center
Department of Pediatrics
Brooklyn, NY 11206
Mailing address
760 Broadway, Woodhull Medical & Mental Health Center
Department of Pediatrics Room 2B-321
Brooklyn, NY 11206
Phone (718) 963-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01358387 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160531002144 | NY | Order and Referring Only - Pediatric Medicine | 0840580064 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 177629 | NY | MD | Pediatrics Physician |
Interoperability endpoints
- lrodriguez562949@nychhc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395964800000",
"number": "1811921349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "760 BROADWAY, WOODHULL MEDICAL & MENTAL HEALTH CENTER",
"address_2": "DEPARTMENT OF PEDIATRICS ROOM 2B-321",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11206",
"telephone_number": "718-963-8000",
"fax_number": "718-630-3122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 BROADWAY, WOODHULL MEDICAL & MENTAL HEALTH CENTER",
"address_2": "DEPARTMENT OF PEDIATRICS",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11206",
"telephone_number": "718-963-8000",
"fax_number": "718-630-3122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "LUIS",
"middle_name": "RAMON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2014-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "177629",
"primary": true
},
{
"code": "2080P0204X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Emergency Medicine",
"state": "NY",
"license": "177629",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01358387",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.