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DR. ANGEL EMMANUEL RODRIGUEZ PENA DDS, MSD
NPI 1639650245
Dentist - Periodontics in Tyler, TX

Active since August 22, 2018Opted out of Medicare · through Jun 6, 2027
8938 S BROADWAY AVE STE 480, TYLER, TX 75703(918) 801-8124 Get Directions Write a Review

NPPES record last updated: February 23, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 23, 2022, Dec 2, 2021, Aug 22, 2018 (3 updates tracked since 2018).

About Dr. Angel Emmanuel Rodriguez Pena Dds, Msd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ANGEL EMMANUEL RODRIGUEZ PENA DDS, MSD (NPI 1639650245) is an individual periodontics provider in Tyler, Texas, licensed in California (104508) and active in the NPI registry since August 2018. He has opted out of Medicare through June 6, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1639650245
Entity TypeIndividualMale
Primary Taxonomy1223P0300X
Provider Legal NameDR. ANGEL EMMANUEL RODRIGUEZ PENACredential: DDS, MSD
Location Address8938 S BROADWAY AVE STE 480Tyler, TX 75703-5733
Mailing Address11950 Erwin St Apt 337North Hollywood, CA 91606
Phone(918) 801-8124
Sole ProprietorYes
Enumeration DateAugust 22, 2018
Last NPPES UpdateFebruary 23, 20223 updates tracked since enumeration
NPPES CertifiedFebruary 23, 2022
✔ NPI 1639650245 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
Licenses✔ Licensed in CA · 104508✔ Licensed in TX · 34440
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
8938 S BROADWAY AVE STE 480, Tyler, TX 75703
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Dr. Angel Emmanuel Rodriguez Pena Dds, Msd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from June 6, 2023 through June 6, 2027.

Opt-Out Effective DateJune 6, 2023
Opt-Out In Effect ThroughJune 6, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75703 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$68.55 typical visit price
range $17.52 – $136.11
Typical copayment $17.13 (range $4.38 – $34.02)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Angel Rodriguez Pena's NPI number?

The NPI number for Angel Rodriguez Pena is 1639650245. It was assigned to this individual provider in the NPPES registry on August 22, 2018.

Where is Angel Rodriguez Pena located?

Angel Rodriguez Pena practices at 8938 S Broadway Ave Ste 480, Tyler, TX 75703. The listed phone number is (918) 801-8124.

What is Angel Rodriguez Pena's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Is Angel Rodriguez Pena enrolled in Medicare?

No. Angel Rodriguez Pena has opted out of Medicare through June 6, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Angel Rodriguez Pena accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and HRI Dental & Vision and 3 other insurers list Angel Rodriguez Pena as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Angel Rodriguez Pena was last updated on February 23, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.