Individual provider Active NPI

Stephen M Roos

  • Marriage & Family Therapist
  • Sonora, CA
National Provider Identifier
1144889064
Registry record updated Jun 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
AMFT112531 Issued in CA
Practice address
105 Hospital Rd
Sonora, CA 95370-5227
Phone
(209) 533-6245
NPI assigned
Jun 13, 2019
Last updated
Jun 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X AMFT112531 CA Primary

Addresses

Primary practice location

105 Hospital Rd
Sonora, CA 95370-5227

Mailing address

2 S Green St
Sonora, CA 95370-4618
Phone (209) 533-6245

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240410002416 CA Practitioner - Marriage and Family Therapist 9931547841

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2 S Green St
Sonora, CA 95370-4618

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AMFT112531CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
County of Tuolumne CurrentSince Feb 7, 2024 Accepting new patients

Locations

105 Hospital Rd
Sonora, CA 95370
Phone (209) 533-6245

2 S Green St
Sonora, CA 95370

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.

NPI Registry JSON

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560384000000",
    "number": "1144889064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 S GREEN ST",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953704618",
            "telephone_number": "209-533-6245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 HOSPITAL RD",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705227",
            "telephone_number": "209-533-6245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOS",
        "first_name": "STEPHEN",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-13",
        "last_updated": "2019-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "AMFT112531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonora, CA

Sources for this page

Verify at the official NPI Registry.