Active NPI
Diego Armando Rodriguez, DMD
- Periodontics
- Agawam, MA
National Provider Identifier
1952869810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DN1859153
- Practice address
- 158 Main St Ste 101
Agawam, MA 01001-1803 - Phone
- (413) 207-0999
- NPI assigned
- Mar 8, 2019
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1859153 | MA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | PR | ||
| Periodontics | 1223P0300X | DN1859153 | MA | Primary |
Addresses
Primary practice location
158 Main St Ste 101
Agawam, MA 01001-1803
Mailing address
99 Kneeland St Apt 506
Boston, MA 02111-2435
Phone (787) 605-5790
Other practice location 1
1 Kneeland St Fl 12
Boston, MA 02111-1527
Phone (617) 636-2687
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220407000747 | MA | Order and Referring Only - Dentist | 9931595501 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1859153 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726790400000",
"number": "1952869810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 KNEELAND ST APT 506",
"city": "BOSTON",
"state": "MA",
"postal_code": "021112435",
"telephone_number": "787-605-5790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "158 MAIN ST STE 101",
"city": "AGAWAM",
"state": "MA",
"postal_code": "010011803",
"telephone_number": "413-207-0999"
}
],
"practiceLocations": [
{
"address_1": "1 Kneeland St Fl 12",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021111527",
"country_code": "US",
"telephone_number": "617-636-2687",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "DIEGO",
"middle_name": "ARMANDO",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-08",
"last_updated": "2024-09-20",
"certification_date": "2024-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1859153",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "PR",
"license": null,
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MA",
"license": "DN1859153",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Agawam, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; 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.