Johnathon Curtis Rollo, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

A130427 Issued in CA

Practice address

200 UCLA Medical PLZ Ste 526
Los Angeles, CA 90095-8414

Phone

(310) 206-6294

NPI assigned

May 3, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA, WY2 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

Specialty

Vascular Surgery

Education

University of Miami, LM Miller School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Casper Medical Imaging PCGroup PAC ID 8224010871, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Wyoming Medical Center Hospital, Casper, WY, CCN 530012

Merit-based Incentive Payment System (MIPS)

Final score

96.94 of 100Reported as group

Quality

83.77

Promoting interoperability

100

Improvement activities

40

Cost

72.71

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: johnathon.rollo.1@29134.direct.athenahealth.com

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.

• Casper Medical Imaging, P.C.

  • Diagnostic Radiology Physician
  • Casper, WY
  • NPI 1316908940

  Multi-Specialty, WY

  Medicare reassignment Care Compare group NPD
• Teton Advanced Therapies P.C.

  • Vascular Surgery Physician
  • Casper, WY
  • NPI 1144109646

  Multi-Specialty, WY

  Medicare reassignment NPD Authorized official
• Leo Polosajian MD a Professional Med Corp

  • Clinical Cardiac Electrophysiology Physician
  • Reseda, CA
  • NPI 1912122631

  CA, Multi-Specialty

  Medicare reassignment NPD
• Noninvasive Medical Imaging Incorporated

  • Medical Specialty Clinic/Center
  • Reseda, CA
  • NPI 1255899209

  Multi-Specialty

  NPD
• Wyoming Wound Care Center PC

  • Physical Therapy Clinic/Center
  • Casper, WY
  • NPI 1356414445

  Multi-Specialty

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Wyoming Medical Center Inc

  • General Acute Care Hospital
  • Casper, WY
  • NPI 1346332954

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1336003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1104185644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UCLA MEDICAL PLZ STE 526",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958414",
            "telephone_number": "310-206-6294"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1560 N 115th St",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981338414",
            "country_code": "US",
            "telephone_number": "206-668-5864",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Ucla Medical Plz Ste 528",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900958414",
            "country_code": "US",
            "telephone_number": "310-267-0172",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROLLO",
        "first_name": "JOHNATHON",
        "middle_name": "CURTIS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-03",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "WA",
            "license": "MD60748391",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A130427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "8967381",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104185644",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawn C Roll, PHD, OTR/L, RMSKS
• Tajhicia Rolle, MSW, MSCJ
• Raquel Roller
• Darren Rollerson, RPH
• Jordan Albert Rollerson
• Benjamin Rolon-Arroyo, PH.D.
• Adriana Rolon
• Kevin Rolon
• Daniel Mark Rolston, M.D.
• Tina June Romain

• Vascular Surgery Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Vascular Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.