Individual provider Active NPI

Rogelio Cantu, PA-C

  • Physician Assistant
  • Spokane, WA
National Provider Identifier
1942238886
Registry record updated Apr 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10004216 Issued in WA
Practice address
3919 N Maple St
Spokane, WA 99205-1349
Phone
(509) 444-8200
Fax
(509) 444-7806
NPI assigned
Jun 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA10004216 WA Primary

Addresses

Primary practice location

3919 N Maple St
Spokane, WA 99205-1349

Mailing address

611 N Iron Bridge Way
Spokane, WA 99202-4932
Phone (509) 444-8888

Other identifiers 1

IdentifierTypeStateIssuer
8331282MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20100903000659 WA Practitioner - Physician Assistant 6406970920 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA10004216WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Association of Spokane CurrentSince Oct 21, 2002 Accepting new patients
Community Health Association of Spokane CurrentSince Oct 21, 2002 Accepting new patients
Community Health Association of Spokane Past Accepting new patients

Locations

611 N Iron Bridge Way
Spokane, WA 99202

1001 W 2nd Ave
Spokane, WA 99201
Phone (509) 835-1205

203 N Washington St
Ste 300
Spokane, WA 99201

3919 N Maple St
Spokane, WA 99205
Phone (509) 326-6900

Interoperability endpoints

  • Direct secure messaging: rogelio.cantu.1@11411.direct.athenahealth.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1942238886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888",
            "fax_number": "509-444-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 N MAPLE ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992051349",
            "telephone_number": "509-444-8200",
            "fax_number": "509-444-7806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANTU",
        "first_name": "ROGELIO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8331282",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.