Patrick T. Roughneen, M.D., P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

J1480 Issued in TX

Legal business name

PATRICK T. ROUGHNEEN, M.D., P.A.

Practice address

1600 W College St
Suite 555
Grapevine, TX 76051-3580

Phone

(817) 552-1900

Fax

(817) 552-1902

NPI assigned

May 10, 2007

Organization subpart

No

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

Authorized official

Name

Kimchi T Nguyen

Title

Office Manager

Phone

(817) 552-1900

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273795200000",
    "number": "1194939728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W COLLEGE ST",
            "address_2": "SUITE 555",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513580",
            "telephone_number": "817-552-1900",
            "fax_number": "817-552-1902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W COLLEGE ST",
            "address_2": "SUITE 555",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513580",
            "telephone_number": "817-552-1900",
            "fax_number": "817-552-1902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICK T. ROUGHNEEN, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2010-05-14",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "KIMCHI",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "817-552-1900"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "J1480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171001404",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Grapevine, TX
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.