Active NPI
Samuel Roll, PH.D.
- Clinical Psychologist
- Albuquerque, NM
National Provider Identifier
1144332925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 105
- Practice address
- 201 Tulane Dr SE
Albuquerque, NM 87106-1413 - Phone
- (505) 255-9494
- Fax
- (505) 242-4763
- NPI assigned
- Aug 31, 2006
- Last updated
- May 12, 2008
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 105 | NM | Primary |
Addresses
Primary practice location
201 Tulane Dr SE
Albuquerque, NM 87106-1413
Mailing address
1616 San Patricio Ave SW
Albuquerque, NM 87104-1048
Phone (505) 255-9494
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105 | Other | NM | NM LICENSE NO |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105 | NM | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Samuel Roll PHD and Elizabeth J Roll PHD PA | Clinical | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Psychologist
- Albuquerque, NM
- NPI 1548443948
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210550400000",
"number": "1144332925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1616 SAN PATRICIO AVE SW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871041048",
"telephone_number": "505-255-9494",
"fax_number": "505-242-4763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 TULANE DR SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871061413",
"telephone_number": "505-255-9494",
"fax_number": "505-242-4763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLL",
"first_name": "SAMUEL",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2008-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NM",
"license": "105",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NM LICENSE NO",
"identifier": "105",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.