Individual provider Active NPI

Luis Rosa, MD

  • Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1063608958
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
18112 Issued in PR
Practice address
3400 Spruce St
1 Maloney
Philadelphia, PA 19104-4206
Phone
(215) 662-3957
NPI assigned
Sep 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MT191873 PA
General Practice Physician 208D00000X 18112 PR
Surgery Physician 208600000X 18112 PR Primary

Addresses

Primary practice location

3400 Spruce St
1 Maloney
Philadelphia, PA 19104-4206

Mailing address

3400 Spruce St
1 Maloney
Philadelphia, PA 19104-4206
Phone (215) 662-3957

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160315002241 TX Practitioner - Emergency Medicine 4981882354 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
70.2 of 100Reported as group
Quality
74.9
Improvement activities
40
Cost
20.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT191873PAMDSurgery Physician
18112PRMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Carlos Apache Healthcare Corporation Current Accepting new patients
Irene Benn Medical Center CurrentSince Sep 1, 2024 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Sep 1, 2024 Accepting new patients
DHHS IHS Phoenix Area Current Accepting new patients
DHHS IHS Phoenix Area Family Medicine CurrentSince Jul 21, 2018 Accepting new patients
San Carlos Apache Healthcare Corporation CurrentSince Aug 9, 2018 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Sep 1, 2024 Accepting new patients
Eagle Butte Indian Health Service Hospital CurrentSince Feb 22, 2016 Accepting new patients
DHHS IHS Phoenix CurrentSince Sep 1, 2024 Accepting new patients

Locations

12033 Agency Rd
Parker, AZ 85344
Phone (760) 572-4137

103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435104000000",
    "number": "1063608958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "1 MALONEY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-3957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "1 MALONEY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-3957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSA",
        "first_name": "LUIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-24",
        "last_updated": "2015-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MT191873",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "18112",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PR",
            "license": "18112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.