Shantae Rodriguez, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

012566 Issued in NY

Practice address

Stony Brook Medicine Em
100 Nicolls Road, HSC, Level 4, Room 080
Stony Brook, NY 11794-8350

Phone

(631) 444-2478

Fax

(631) 444-3919

NPI assigned

Sep 17, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Urgent Care of New York PLLCGroup PAC ID 2466816525, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: shantae.rodriguez.1@15450.direct.athenahealth.com

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.

• Urgent Care of New York PLLC

  • Urgent Care Clinic/Center
  • Centereach, NY
  • NPI 1962181925
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489622400000",
    "number": "1902055650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1554",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117900988",
            "telephone_number": "631-444-2478",
            "fax_number": "631-444-3919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STONY BROOK MEDICINE EM",
            "address_2": "100 NICOLLS ROAD, HSC, LEVEL 4, ROOM 080",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948350",
            "telephone_number": "631-444-2478",
            "fax_number": "631-444-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "SHANTAE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-17",
        "last_updated": "2017-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "012566",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "012566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "012566",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA CERT.#",
            "identifier": "1079871",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rocco Caruso, MD
• Patricia E Roche, D.O.
• Abigail Rockett, N.P.
• Roberto Rodriguez II, N.P.
• Daniel Rodriguez
• Emily Elizabeth Roff, DO
• Jennifer Laura Rogak, LCSW R
• Paul Rogak, PA
• Dillon Oliver Rogando, MD
• Annie Rohan, PHD, RNC, NNP/PNP-BC

• Physician Assistant in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.