NPIMap

Organization Active NPI

Roller Weight Loss Institute,Inc.

  • Specialist
  • Fayetteville, AR
National Provider Identifier
1073743399
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
E5193 Issued in AR
Legal business name
ROLLER WEIGHT LOSS INSTITUTE,INC.
Practice address
1695 E Rainforest Rd
Fayetteville, AR 72703-5385
Phone
(479) 445-6460
Fax
(479) 445-6719
NPI assigned
Jul 21, 2009
Last updated
Aug 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Authorized official

Name
Dr. Joshua Ernest Roller, M.D.NPI 1790713675
Title
President/Ceo
Phone
(479) 445-6460

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X E5193 AR Primary
Surgery Physician 208600000X NU

Addresses

Primary practice location

1695 E Rainforest Rd
Fayetteville, AR 72703-5385

Mailing address

1695 E Rainforest Rd
Fayetteville, AR 72703-5385
Phone (479) 445-6460

Other practice location 1

12112 Highway 71 S
Fort Smith, AR 72916-8405
Phone (479) 434-6222

Other practice location 2

3311 E 46th St
Tulsa, OK 74135-2903
Phone (918) 970-6366

Other identifiers 2

IdentifierTypeStateIssuer
200624510AMedicaidOK
211552002MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091106000368 AR Part B Supplier - Clinic/Group Practice 0446398770 Receives reassigned benefits from 43 practitioners
Practice locations: Fayetteville, AR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1280 E Stearns St
Ste 5
Fayetteville, AR 72703
Phone (479) 445-6460

1695 E Rainforest Rd
Fayetteville, AR 72703
Phone (479) 445-6460

1695 E Rainforest Rd
Ste 2
Fayetteville, AR 72703
Phone (479) 445-6460

Practitioners & affiliated clinicians

Practitioners 46

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.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1248134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1073743399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 E RAINFOREST RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035385",
            "telephone_number": "479-445-6460",
            "fax_number": "479-445-6719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 E RAINFOREST RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035385",
            "telephone_number": "479-445-6460",
            "fax_number": "479-445-6719"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12112 Highway 71 S",
            "address_purpose": "LOCATION",
            "city": "Fort Smith",
            "state": "AR",
            "postal_code": "729168405",
            "country_code": "US",
            "telephone_number": "479-434-6222",
            "fax_number": "479-445-6719",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3311 E 46th St",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741352903",
            "country_code": "US",
            "telephone_number": "918-970-6366",
            "fax_number": "479-445-6719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ROLLER WEIGHT LOSS INSTITUTE,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-21",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "ROLLER",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "ERNEST",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "479-445-6460",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AR",
            "license": "E5193",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200624510A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "211552002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.