Brian Roeder, P.A.-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

C00624 Issued in MD

Practice address

301 Hospital Dr
Suite 803
Glen Burnie, MD 21061-5803

Phone

(410) 553-8160

Fax

(410) 553-8159

NPI assigned

Jul 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tidalhealth Specialty Care LLCGroup PAC ID 7113340845, 375 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tidalhealth Peninsula Regional, Inc Hospital, Salisbury, MD, CCN 210019

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: broeder11719@direct.umm.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tidalhealth Specialty Care, LLC

  • Medical Specialty Clinic/Center
  • Salisbury, MD
  • NPI 1619504735

  MD

  Medicare reassignment Care Compare group
• University of Maryland Community Medical Group, Inc.

  • Family Medicine Physician
  • Baltimore, MD
  • NPI 1477530624

  MD

  Medicare reassignment
• Tidalhealth Specialty Care, LLC

  • Orthopaedic Surgery Physician
  • Ocean Pines, MD
  • NPI 1225986003
  Care Compare group
• Tidalhealth Specialty Care, LLC

  • Orthopaedic Surgery Physician
  • Salisbury, MD
  • NPI 1881542678
  Care Compare group
• Tidalhealth Specialty Care, LLC

  • Orthopaedic Surgery Physician
  • Lewes, DE
  • NPI 1134077845
  Care Compare group
• Tidalhealth Specialty Care, LLC

  • Orthopaedic Surgery Physician
  • Seaford, DE
  • NPI 1164370854
  Care Compare group
• Tidalhealth Specialty Care, LLC

  • Orthopaedic Surgery Physician
  • Millsboro, DE
  • NPI 1477497725
  Care Compare group
• Tidalhealth Specialty Care, LLC

  • Orthopaedic Surgery Physician
  • Millsboro, DE
  • NPI 1902754609
  Care Compare group
• University of Maryland Community Medical Group, Inc.

  • Psychiatry Physician
  • La Plata, MD
  • NPI 1679393854
  NPD
• Greater Baltimore Medical Center, Inc.

  • Sleep Medicine (Internal Medicine) Physician
  • Baltimore, MD
  • NPI 1538029731
  NPD (past)
• Tidalhealth Specialty Care, LLC

  • Adult Mental Health Clinic/Center
  • Salisbury, MD
  • NPI 1962027094
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Tidalhealth Peninsula Regional, Inc.

  • General Acute Care Hospital
  • Salisbury, MD
  • NPI 1780689463

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447027200000",
    "number": "1023034170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 HOSPITAL DR",
            "address_2": "SUITE 803",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615803",
            "telephone_number": "410-553-8160",
            "fax_number": "410-553-8159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HOSPITAL DR",
            "address_2": "SUITE 803",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615803",
            "telephone_number": "410-553-8160",
            "fax_number": "410-553-8159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROEDER",
        "first_name": "BRIAN",
        "name_prefix": "Mr.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2015-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C00624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER PERM",
            "identifier": "236285",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "75551",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaiser J. Robertson III, M.D.
• Robin Smith
• Ladonna Robinson, PTA
• Lashonda Robinson, OTR/L
• Della Roderick, LCPC
• Dawn Marie Roelofs, NP-C, CRNP
• Rebecca Rogers-McCoy, CSC-AD
• Harmony Rogers
• Mary Jane Rogers, LCPC
• Eric Roher, DPT

• All providers in Glen Burnie, MD
• Surgical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.