Active NPI
Lisa Denise Roark, MD
- Family Medicine Physician
- Aurora, MO
National Provider Identifier
1013198902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2008017231
- Practice address
- 106 Commerce Drive
Aurora, MO 65605-6260 - Phone
- (417) 269-2400
- Fax
- (417) 269-2410
- NPI assigned
- Nov 19, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2008017231 | MO | Primary |
Addresses
Primary practice location
106 Commerce Drive
Aurora, MO 65605-6260
Mailing address
3800 S. National Ave
Ste. 540
Springfield, MO 65807-5284
Phone (417) 269-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 22, 2019 through Feb 22, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353369600000",
"number": "1013198902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3800 S. NATIONAL AVE",
"address_2": "STE. 540",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658075284",
"telephone_number": "417-269-2400",
"fax_number": "417-269-2410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 COMMERCE DRIVE",
"city": "AURORA",
"state": "MO",
"postal_code": "656056260",
"telephone_number": "417-269-2400",
"fax_number": "417-269-2410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROARK",
"first_name": "LISA",
"middle_name": "DENISE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-19",
"last_updated": "2012-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2008017231",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.