Individual provider Active NPI

Joshua Roose

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1174086664
Registry record updated Sep 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO3474 Issued in NV
Practice address
11860 Southern Highlands Pkwy Ste 100
Las Vegas, NV 89141-3304
Phone
(702) 383-2273
Fax
(702) 224-7180
NPI assigned
Apr 11, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO3474 NV Primary
Family Medicine Physician 207Q00000X FR3405950 NV

Addresses

Primary practice location

11860 Southern Highlands Pkwy Ste 100
Las Vegas, NV 89141-3304

Mailing address

1800 W Charleston Blvd
Las Vegas, NV 89102-2329
Phone (702) 383-2000

Other practice location 1

1524 Pinto Ln Fl 2
Las Vegas, NV 89106-4195
Phone (702) 383-2273

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260402000362 CA Practitioner - Family Practice 3779908926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

1335 S Fairmont Ave
Lodi, CA 95240-5520
Phone (209) 366-2007

815 Court St
Jackson, CA 95642-2154

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO3474NVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Center of Southern Nevada CurrentSince Jul 8, 2024 Accepting new patients

Locations

11860 Southern Highlands Pkwy
Ste 100
Las Vegas, NV 89141
Phone (702) 383-6230

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

1524 Pinto Ln
Fl 2
Las Vegas, NV 89106
Phone (702) 671-2236

2202 W Craig Rd
North Las Vegas, NV 89032
Phone (702) 826-3200

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": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1174086664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022329",
            "telephone_number": "702-383-2000",
            "fax_number": "702-224-7180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11860 SOUTHERN HIGHLANDS PKWY STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891413304",
            "telephone_number": "702-383-2273",
            "fax_number": "702-224-7180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1524 Pinto Ln Fl 2",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891064195",
            "country_code": "US",
            "telephone_number": "702-383-2273",
            "fax_number": "702-383-1982",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROOSE",
        "first_name": "JOSHUA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-11",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "DO3474",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "FR3405950",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.