NPIMap

Organization Active NPI

Roseman Medical Research Institute

Doing business as Roseman Medical Group

  • Addiction (Substance Use Disorder) Counselor
  • Las Vegas, NV
National Provider Identifier
1063135796
Registry record updated Sep 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
ROSEMAN MEDICAL RESEARCH INSTITUTE
Doing business as
Roseman Medical Group
Practice address
1 Breakthrough Way
Las Vegas, NV 89135-3011
Phone
(702) 802-2851
NPI assigned
Sep 19, 2022
Last updated
Sep 19, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ROSEMAN ROSEMAN MEDICAL RESEARCH INSTITUTEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 19, 2022

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

Authorized official

Name
Kristina Lee Connolly
Title
Sr. Exe Dean, Finance & Operation
Phone
(702) 802-2878

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU Primary
Addiction (Substance Use Disorder) Psychologist 103TA0400X NU
Clinical Social Worker 1041C0700X NU
Peer Specialist 175T00000X NU

Addresses

Primary practice location

1 Breakthrough Way
Las Vegas, NV 89135-3011

Mailing address

10530 Discovery Dr
Las Vegas, NV 89135-3050
Phone (702) 802-2878

Other names 1

  • Roseman Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Roseman Medical Research3 organizations share this tax ID, including this one
Part of
Roseman Medical Research

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663545600000",
    "number": "1063135796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10530 DISCOVERY DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891353050",
            "telephone_number": "702-802-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BREAKTHROUGH WAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891353011",
            "telephone_number": "702-802-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEMAN MEDICAL RESEARCH INSTITUTE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROSEMAN ROSEMAN MEDICAL RESEARCH INSTITUTE",
        "enumeration_date": "2022-09-19",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A",
        "authorized_official_last_name": "CONNOLLY",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "SR. EXE DEAN, FINANCE & OPERATION",
        "authorized_official_telephone_number": "702-802-2878"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roseman Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.