NPIMap

Individual provider Active NPI

Rodolfo Leongson San Juan Jr., M.D.

  • Family Medicine Physician
  • Crown Point, IN
National Provider Identifier
1881895233
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01064429A Issued in IN
Practice address
11161 Randolph St
Crown Point, IN 46307-8564
Phone
(219) 662-9424
Fax
(219) 662-7465
NPI assigned
May 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0116017383 VA
Family Medicine Physician 207Q00000X 01064429A IN Primary

Addresses

Primary practice location

11161 Randolph St
Crown Point, IN 46307-8564

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other identifiers 1

IdentifierTypeStateIssuer
200386920MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rsanjuan6611@Direct.FranciscanAlliance.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080326000935 IN Practitioner - General Practice 5698851962 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

11161 Randolph St
Crown Point, IN 46307-8564
Phone (219) 662-9424

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0116017383VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network Family Medicine CurrentSince Aug 1, 2011 Accepting new patients
Franciscan Physician Network CurrentSince Aug 1, 2011 Accepting new patients

Locations

35682 Eagle Way
Chicago, IL 60678

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

1201 S Main St
Crown Point, IN 46307
Phone (219) 738-2100

11161 Randolph St
Crown Point, IN 46307
Phone (219) 662-9424

1040 Sierra Dr
Ste 400
Greenwood, IN 46143
Phone (317) 528-4886

900 I St
Laporte, IN 46350
Phone (219) 324-1670

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

Interoperability endpoints

  • Direct secure messaging: rsanjuan6611@direct.franciscanalliance.org

Organizations & group practices 2

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 10

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": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694649600000",
    "number": "1881895233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11161 RANDOLPH ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078564",
            "telephone_number": "219-662-9424",
            "fax_number": "219-662-7465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAN JUAN",
        "first_name": "RODOLFO",
        "middle_name": "LEONGSON",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-31",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0116017383",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01064429A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200386920",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rsanjuan6611@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11161 Randolph St",
            "city": "Crown Point",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463078564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.