Individual provider Active NPI

Jonathan Roach, MD

  • Pediatric Surgery Physician
  • Aurora, CO
National Provider Identifier
1073650362
Registry record updated Dec 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
48258 Issued in CO
Practice address
13123 E 16TH Ave
Aurora, CO 80045-7106
Phone
(720) 777-1234
NPI assigned
Jan 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X MD2017-0745 NM
Pediatric Surgery Physician 2086S0120X 48258 CO Primary

Addresses

Primary practice location

13123 E 16TH Ave
Aurora, CO 80045-7106

Mailing address

PO Box 110429
Aurora, CO 80042-0429
Phone (303) 493-7000

Other practice location 1

University Of Colorado School Of Medicine
4200 E. 9th Ave.
Denver, CO 80262-0001
Phone (303) 493-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, NM2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140927000253 CO Practitioner - General SurgeryPractitioner - Pediatric Medicine 7315167236 Reassigns benefits to 2 organizations
I20171114000559 NM Practitioner - General Surgery 7315167236 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Pediatric Medicine
Education
Sanford School of Medicine of University of South Dakota, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physicians IncorporatedGroup PAC ID 3476465667, 3,189 clinicians

Practice addresses (Care Compare)

13123 E 16TH Ave
Aurora, CO 80045-7106
Phone (720) 777-1234

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48258COMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Colorado Current Accepting new patients
Unm Medical Group, Inc. CurrentSince Oct 20, 2017 Accepting new patients
University Physicians Incorporated Family Medicine CurrentSince Aug 1, 2014 Accepting new patients
University Physicians, Incorporated CurrentSince Aug 1, 2014 Accepting new patients
Denver Health and Hospital Authority CurrentSince Aug 1, 2014 Accepting new patients
Unm Medical Group Inc CurrentSince Oct 20, 2017 Accepting new patients
Denver Health and Hospital Authority CurrentSince Aug 1, 2014 Accepting new patients
Children'S Hospital Colorado Past Accepting new patients
Denver Health and Hospital Authority Past Accepting new patients

Locations

13123 E 16th Ave
Ste B130
Aurora, CO 80045

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

4090 Briargate Pkwy
Colorado Springs, CO 80920
Phone (719) 305-1234

Dept 1061
Denver, CO 80256

777 Bannock St
Denver, CO 80204

777 Bannock St
Ste MC3450
Denver, CO 80204

933 Bradbury Dr SE
Ste 2222
Albuquerque, NM 87106
Phone (505) 272-1476

2211 Lomas Blvd NE
Unm, NM 87106
Phone (505) 272-1111

Interoperability endpoints

  • Direct secure messaging: jroach1791@direct.childrenscolorado.org

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": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512950400000",
    "number": "1073650362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110429",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800420429",
            "telephone_number": "303-493-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13123 E 16TH AVE",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800457106",
            "telephone_number": "720-777-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "University Of Colorado School Of Medicine",
            "address_2": "4200 E. 9th Ave.",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802620001",
            "country_code": "US",
            "telephone_number": "303-493-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROACH",
        "first_name": "JONATHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2017-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "NM",
            "license": "MD2017-0745",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "CO",
            "license": "48258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.