Active NPI
Jesse Roach, M.D.
- Pediatric Nephrology Physician
- Madison, WI
National Provider Identifier
1003930553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nephrology Physician
- License
- 54320
- Practice address
- 600 Highland Ave
Madison, WI 53792-0001 - Phone
- (608) 263-6420
- NPI assigned
- Mar 19, 2007
- Last updated
- Jun 14, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nephrology Physician | 2080P0210X | 54320 | WI | Primary |
Addresses
Primary practice location
600 Highland Ave
Madison, WI 53792-0001
Mailing address
7974 Uw Health CT
Middleton, WI 53562-5531
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54320 | WI | MD | Pediatric Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276473600000",
"number": "1003930553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7974 UW HEALTH CT",
"city": "MIDDLETON",
"state": "WI",
"postal_code": "535625531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 HIGHLAND AVE",
"city": "MADISON",
"state": "WI",
"postal_code": "537920001",
"telephone_number": "608-263-6420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "JESSE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-19",
"last_updated": "2010-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0210X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Nephrology",
"state": "WI",
"license": "54320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.