NPIMap

Individual provider Active NPI

Robbie William Roesch, PA-C

  • Medical Physician Assistant
  • Mount Clemens, MI
National Provider Identifier
1023327483
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601005865 Issued in MI
Practice address
133 S Main St
Mount Clemens, MI 48043-2308
Phone
(586) 468-1600
NPI assigned
Oct 4, 2010
Last updated
Dec 22, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601005865 MI Primary

Addresses

Primary practice location

133 S Main St
Mount Clemens, MI 48043-2308

Mailing address

2405 E. Fourteen Mile Rd.
Sterling Heights, MI 48310
Phone (586) 264-1800

Other practice location 1

2405 E. Fourteen Mile Rd.
Sterling Heights, MI 48310
Phone (586) 264-1800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rroesch368544@direct.hfhs.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110303000506 MI Practitioner - Physician Assistant 4981886538 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Physician PartnersGroup PAC ID 8921482605, 79 clinicians

Practice addresses (Care Compare)

133 S Main St
Mount Clemens, MI 48043-2308
Phone (586) 468-1600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601005865MIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine Associates of Mt. Clemens, PC Current Accepting new patients
Henry Ford Macomb Ancillary Services Current Accepting new patients

Locations

133 S Main St
Mount Clemens, MI 48043
Phone (586) 329-1880

Interoperability endpoints

  • Direct secure messaging: rroesch368544@direct.hfhs.org

Organizations & group practices 4

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

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1286150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1023327483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2405 E. FOURTEEN MILE RD.",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "48310",
            "telephone_number": "586-264-1800",
            "fax_number": "586-264-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 S MAIN ST",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432308",
            "telephone_number": "586-468-1600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2405 E. Fourteen Mile Rd.",
            "address_purpose": "LOCATION",
            "city": "Sterling Heights",
            "state": "MI",
            "postal_code": "48310",
            "country_code": "US",
            "telephone_number": "586-264-1800",
            "fax_number": "586-264-1155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROESCH",
        "first_name": "ROBBIE",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-04",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601005865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rroesch368544@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "133 S Main St",
            "city": "Mount Clemens",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480432308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Clemens, MI

Sources for this page

Verify at the official NPI Registry.