Individual provider Active NPI

Martin M. Roche Sr., M.D.

  • Specialist
  • Ft Lauderdale, FL
National Provider Identifier
1164513958
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME13408 Issued in FL
Practice address
103 SE 20TH St
Ft Lauderdale, FL 33316-2846
Phone
(954) 462-7558
Fax
(954) 525-5820
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME13408 FL Primary

Addresses

Primary practice location

103 SE 20TH St
Ft Lauderdale, FL 33316-2846

Mailing address

103 SE 20TH St
Suite 100
Ft Lauderdale, FL 33316-2846
Phone (954) 462-7558

Other identifiers 1

IdentifierTypeStateIssuer
06962OtherFLBLUECROSSBLUESHIELD OF FL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070627000087 FL Practitioner - OphthalmologyPractitioner - Emergency Medicine 8123127453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
OphthalmologyAlso: Emergency Medicine
Education
Other, 1966
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Broward Medical and Urgent Care IncGroup PAC ID 0042342057, 2 clinicians

Practice addresses (Care Compare)

103 SE 20 St
Fort Lauderdale, FL 33316-2846
Phone (954) 462-7558

Hospital & facility affiliations

  • USA Home Health Services, Inc. Home health agency, Delray Beach, FL, CCN 107785

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
56560FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Broward Medical & Urgent Care Inc Specialist CurrentSince Feb 1, 2010 Accepting new patients
Broward Center of Medical Excellence Inc. Current Accepting new patients

Locations

500 SE 17th St
Ste 100
Ft Lauderdale, FL 33316
Phone (954) 462-7558

103 SE 20th St
Ste 100
Ft Lauderdale, FL 33316

103 SE 20th St
Ft Lauderdale, FL 33316
Phone (954) 462-7558

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1164513958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SE 20TH ST",
            "address_2": "SUITE 100",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162846",
            "telephone_number": "954-462-7558",
            "fax_number": "954-525-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SE 20TH ST",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162846",
            "telephone_number": "954-462-7558",
            "fax_number": "954-525-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROCHE",
        "first_name": "MARTIN",
        "middle_name": "M.",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME13408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD OF FL",
            "identifier": "06962",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.