Active NPI
Chad Romanoff
- Pediatric Occupational Therapist
- Mesa, AZ
National Provider Identifier
1104963412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 2504
- Practice address
- 930 W Southern Ave
Ste 101
Mesa, AZ 85210-4938 - Phone
- (480) 835-0857
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 2504 | AZ | Primary |
Addresses
Primary practice location
930 W Southern Ave
Ste 101
Mesa, AZ 85210-4938
Mailing address
4621 E Chandler Blvd
Ste 100
Phoenix, AZ 85048-0425
Phone (480) 893-6514
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 556821 | Medicaid | AZ |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2504 | AZ | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fiesta Pediatric Therapy | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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": "1183852800000",
"number": "1104963412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4621 E CHANDLER BLVD",
"address_2": "STE 100",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850480425",
"telephone_number": "480-893-6514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 W SOUTHERN AVE",
"address_2": "STE 101",
"city": "MESA",
"state": "AZ",
"postal_code": "852104938",
"telephone_number": "480-835-0857"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROMANOFF",
"first_name": "CHAD",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "AZ",
"license": "2504",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "556821",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.