Active NPI
Jack Roudebush
- Behavior Technician
- Indianapolis, IN
National Provider Identifier
1124908074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-25-468472
- Practice address
- 7526 E 82ND St
Indianapolis, IN 46256-1410 - Phone
- (574) 387-4313
- NPI assigned
- Sep 3, 2025
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-25-468472 | IN | Primary |
Addresses
Primary practice location
7526 E 82ND St
Indianapolis, IN 46256-1410
Mailing address
215 Red Coach Dr
Mishawaka, IN 46545-8307
Phone (574) 387-4313
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 |
|---|---|---|---|
| RBT-25-468472 | IN | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756857600000",
"number": "1124908074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 RED COACH DR",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465458307",
"telephone_number": "574-387-4313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7526 E 82ND ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462561410",
"telephone_number": "574-387-4313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUDEBUSH",
"first_name": "JACK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-09-03",
"last_updated": "2025-09-03",
"certification_date": "2025-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IN",
"license": "RBT-25-468472",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.