Individual provider Active NPI

Shaunda Marie Rodriguez, D.O.

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Wichita, KS
National Provider Identifier
1932356078
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
License
05-38208 Issued in KS
Practice address
1947 N Founders Cir
Wichita, KS 67206-3548
Phone
(316) 613-4680
Fax
(316) 613-4906
NPI assigned
Aug 20, 2008
Last updated
Jul 1, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 931 NE
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X OTO12165 PA
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X 05-38208 KS Primary

Addresses

Primary practice location

1947 N Founders Cir
Wichita, KS 67206-3548

Mailing address

PO Box 8035
Wichita, KS 67208-0035
Phone (316) 689-9135

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20150730010812 KS Practitioner - Otolaryngology 2860642618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1947 N Founders Cir
Via Christi Clinic PA
Wichita, KS 67206-3548
Phone (316) 613-4640

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
05-38208KSMDPlastic Surgery within the Head & Neck (Otolaryngology) Physician
OTO12165PAMDPlastic Surgery within the Head & Neck (Otolaryngology) Physician
931NEMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group Via Christi, PA CurrentSince Jul 1, 2015 Accepting new patients
Ascension Medical Group Via Christi, PA CurrentSince Jul 1, 2015 Accepting new patients
Ascension Medical Group Via Christi, PA Past Accepting new patients
Ear, Nose & Throat Associates, P.C. Otolaryngology Past Accepting new patients

Locations

1947 N Founders Cir
Wichita, KS 67206
Phone (316) 613-4640

3311 E Murdock St
Wichita, KS 67208
Phone (316) 689-9107

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435708800000",
    "number": "1932356078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8035",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672080035",
            "telephone_number": "316-689-9135",
            "fax_number": "316-689-9769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1947 N FOUNDERS CIR",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063548",
            "telephone_number": "316-613-4680",
            "fax_number": "316-613-4906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "SHAUNDA",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-20",
        "last_updated": "2015-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NE",
            "license": "931",
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "PA",
            "license": "OTO12165",
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "KS",
            "license": "05-38208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.