Individual provider Active NPI

Samrat Roy, SLP, BCBA

  • Behavior Analyst
  • Santa Clara, CA
National Provider Identifier
1073859724
Registry record updated May 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
1400 Coleman Ave Ste E15-1
Santa Clara, CA 95050-4374
Phone
(408) 244-1743
Fax
(408) 212-9620
NPI assigned
Dec 28, 2012
Last updated
May 19, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP16034 CA
Behavior Analyst 103K00000X NU Primary

Addresses

Primary practice location

1400 Coleman Ave Ste E15-1
Santa Clara, CA 95050-4374

Mailing address

1400 Coleman Ave Ste E15-1
Santa Clara, CA 95050-4374
Phone (408) 244-1743

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
SP16034CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
ABA Spot Behavior Analyst Current Accepting new patients
Nova Health Therapies Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1356652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1073859724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 COLEMAN AVE STE E15-1",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950504374",
            "telephone_number": "408-244-1743",
            "fax_number": "408-212-9620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 COLEMAN AVE STE E15-1",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950504374",
            "telephone_number": "408-244-1743",
            "fax_number": "408-212-9620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROY",
        "first_name": "SAMRAT",
        "name_prefix": "Mr.",
        "credential": "SLP, BCBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-28",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP16034",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Clara, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.