Shad Demar Roundy, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12012276A Issued in IN

Practice address

1601 Medical Arts Blvd Ste 301
Anderson, IN 46011-3460

Phone

(765) 298-4400

Fax

(765) 298-4940

NPI assigned

Jan 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Howard H. Mohler DDS Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Anderson, IN
  • NPI 1740386242
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1164492104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 MEDICAL ARTS BLVD STE 301",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460113460",
            "telephone_number": "765-298-4400",
            "fax_number": "765-298-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 MEDICAL ARTS BLVD STE 301",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460113460",
            "telephone_number": "765-298-4400",
            "fax_number": "765-298-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUNDY",
        "first_name": "SHAD",
        "middle_name": "DEMAR",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AK",
            "license": "173",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12012276A",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12012276B",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DD0083",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessilynn Reese Rose, MD
• Michelle Rose
• Rosemary'S Angels LLC
• Larry Allen Rosenberg, D.P.M.
• Christopher D Roundtree, PA
• Makenzie Nicole Rowe, RBT
• Elaine Rowland-Fisher, LCSW
• Joseph Rowley
• Valerie Ruhayel
• Gina Pease Russel, SLP

• Oral and Maxillofacial Surgery (Dentist) in Anderson, IN
• Providers in Anderson, IN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.