NPIViewer - Provider NPI 1558380790

NPI:	1558380790
Name:	RODOM MEDICAL CONSULTING PA
Entity type:	Organization
Organization Name:	RODOM MEDICAL CONSULTING PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	OWNER
Authorized Official - Prefix:
Authorized Official - First Name:	DOMINICK
Authorized Official - Middle Name:	S
Authorized Official - Last Name:	DAUNNO
Authorized Official - Suffix:
Authorized Official - Credentials:	MD
Authorized Official - Phone:	832-704-6500
Mailing Address - Street 1:	2401 MORSE ST
Mailing Address - Street 2:
Mailing Address - City:	HOUSTON
Mailing Address - State:	TX
Mailing Address - Zip Code:	77019-6731
Mailing Address - Country:	US
Mailing Address - Phone:	713-526-7813
Mailing Address - Fax:
Practice Address - Street 1:	2401 MORSE ST
Practice Address - Street 2:
Practice Address - City:	HOUSTON
Practice Address - State:	TX
Practice Address - Zip Code:	77019-6731
Practice Address - Country:	US
Practice Address - Phone:	281-573-0330
Practice Address - Fax:	713-437-3977
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-07-19
Last Update Date:	2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization	Group
Yes	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Single Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty

State	Identifier ID	ID Type	Issuer
TX	0062PV	Other	BCBS
TX	183752801	Medicaid
TX	286580001	Medicaid
TX	8AG181	Other	BLUE CROSS BLUE SHIELD
TX	1467678250	Other	TEXAS CHILDRENS HEALTHPLAN
TX	20-02144	Other	EVERCARE CHOICE
TX	4318382	Other	CIGNA
TX	8AG184	Other	BLUE CROSS BLIELD SHIELD
TX	116880906	Medicaid
TX	1467678250	Other	EVERCARE
TX	0007978936	Other	AETNA
TX	1467678250	Medicaid
TX	092291603	Medicaid
TX	146772204	Medicaid
TX	860N30	Other	BLUE CROSS BLUE SHIELD
TX	8AG183	Other	BLUE CROSS BLUE SHIELD
TX	8AG187	Other	BLUE CROSS BLUE SHIELD
TX	142056403	Medicaid
TX	1467678250	Other	AMERIGROUP
TX	183751001	Medicaid
TX	01064961	Other	AMERIGROUP
TX	1467678250	Other	MOLINA HEALTHCARE
TX	1467678250	Other	BLUE CROSS BLUE SHIELD
TX	157318003	Medicaid
TX	20-02144	Other	UNITED HEALTHCARE
TX	8AG180	Other	BLUE CROSS BLUE SHIELD
TX	8AG182	Other	BLUE CROSS BLUE SHIELD
TX	1467678250	Other	EVERCARE
TX	8AG182	Other	BLUE CROSS BLUE SHIELD
TX	=========	Other	HUMANA
TX	1467678250	Other	TEXAS CHILDRENS HEALTHPLAN
TX	1467678250	Other	MOLINA HEALTHCARE
TX	116880906	Medicaid
TX	8F3785	Medicare PIN
TX	1467678250	Other	AMERIGROUP
TX	146772204	Medicaid
TX	183752801	Medicaid
TX	1467678250	Medicare PIN