Individual provider Active NPI

Judah Samuel David Rome

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesa, AZ
National Provider Identifier
1144832916
Registry record updated Nov 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RNP246500 Issued in AZ
Practice address
2204 S Dobson Rd Ste 102
Mesa, AZ 85202-6457
Phone
(480) 500-1936
NPI assigned
Aug 21, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RNP246500 AZ Primary

Addresses

Primary practice location

2204 S Dobson Rd Ste 102
Mesa, AZ 85202-6457

Mailing address

3101 N Central Ave Ste 550
Phoenix, AZ 85012-2635
Phone (602) 230-7373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200908003451 AZ Practitioner - Nurse Practitioner 4981022944 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Denova Collaborative Health, LLCGroup PAC ID 2466437736, 141 clinicians

Practice addresses (Care Compare)

2204 S Dobson Rd
Suite 102
Mesa, AZ 85202-6457
Phone (602) 230-7373

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RNP246500AZMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Denova Collaborative Health, LLC CurrentSince Aug 31, 2020 Accepting new patients
Denova Collaborative Health, LLC Current Accepting new patients
Denova Collaborative Health, LLC CurrentSince Aug 31, 2020 Accepting new patients

Locations

235 W Western Ave
Avondale, AZ 85323
Phone (623) 772-5091

2204 S Dobson Rd
Mesa, AZ 85202
Phone (480) 757-6457

2120 W Guadalupe Rd
Ste 6
Mesa, AZ 85202
Phone (480) 629-8577

2204 S Dobson Rd
Ste 102
Mesa, AZ 85202

3101 N Central Ave
Ste 550
Phoenix, AZ 85012

3033 N Central Ave
Ste 700
Phoenix, AZ 85012
Phone (602) 281-7289

77 E Columbus Ave
Ste 210
Phoenix, AZ 85012

3101 N Central Ave
Ste 500
Phoenix, AZ 85012

9014 S Central Ave
Phoenix, AZ 85042
Phone (602) 384-8820

3620 N 3rd St
Phoenix, AZ 85012
Phone (602) 329-8250

Interoperability endpoints

  • Direct secure messaging: denova.judahrome@141317.advancedmd-direct.com

Organizations & group practices 3

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": "1597968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1144832916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 N CENTRAL AVE STE 550",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122635",
            "telephone_number": "602-230-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 S DOBSON RD STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852026457",
            "telephone_number": "480-500-1936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROME",
        "first_name": "JUDAH",
        "middle_name": "SAMUEL DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-21",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "RNP246500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.