Individual provider Active NPI

Roman G. McInnerney, DO

  • Pediatrics Physician
  • San Diego, CA
National Provider Identifier
1205321163
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
20A17994 Issued in CA
Practice address
3020 Childrens Way
San Diego, CA 92123-4223
Phone
(858) 966-8800
NPI assigned
Jun 24, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X T4000 TX
Pediatrics Physician 208000000X T4000 TX
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 011878 AZ
Pediatrics Physician 208000000X 20A17994 CA Primary

Addresses

Primary practice location

3020 Childrens Way
San Diego, CA 92123-4223

Mailing address

3020 Childrens Way # Mc5003
San Diego, CA 92123-4223
Phone (858) 309-6300

Other practice location 1

333 N Santa Rosa
San Antonio, TX 78207-3108
Phone (210) 704-4100

Other practice location 2

2400 S Avenue A
Yuma, AZ 85364-7127
Phone (928) 344-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AZ, CA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20220617001775 TX Practitioner - Pediatric Medicine 1658608609 Reassigns benefits to 3 organizations
I20250826002526 AZ Practitioner - Pediatric Medicine 1658608609 Reassigns benefits to 1 organization
I20250911004594 CA Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 1658608609 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

16426 La Madera Rio
Helotes, TX 78023-3746

3020 Children's Way
San Diego, CA 92123-4223

5651 Copley Dr
Suite a
San Diego, CA 92111-7903

PO Box
Las Vegas, NV 89193

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
T4000TXMDEmergency Medicine Physician
20A17994CAMDPediatrics Physician
011878AZMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rady Children's Hospital San Diego Pediatrics CurrentSince Aug 29, 2025 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc Emergency Medicine CurrentSince Jun 30, 2025 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Jun 30, 2025 Accepting new patients
Rady Children's Hospital San Diego CurrentSince Aug 29, 2025 Accepting new patients
Emergency Medicine Services of TX, PLLC Emergency Medicine CurrentSince Apr 1, 2023 Accepting new patients
Baylor College of Medicine Pediatrics CurrentSince Sep 1, 2024 Accepting new patients
Sierra Estrellas Emergency Physicians LLC Emergency Medicine CurrentSince Jul 29, 2025 Accepting new patients
Community Medicine Associates Pediatrics CurrentSince Jul 1, 2022 Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation PastSince Apr 10, 2022 Accepting new patients

Locations

1500 S Mill Ave
Tempe, AZ 85281
Phone (480) 784-5500

2400 S Avenue A
Yuma, AZ 85364
Phone (928) 336-7100

25170 Hancock Ave
Murrieta, CA 92562
Phone (858) 757-3277

3020 Childrens Way
San Diego, CA 92123
Phone (858) 966-5841

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

3020 Childrens Way
#5003
San Diego, CA 92123
Phone (858) 309-6300

5651 Copley Dr
Ste A
San Diego, CA 92111
Phone (858) 262-6109

8701 Cuyamaca St
Santee, CA 92071
Phone (619) 568-8025

903 W Martin St
#492
San Antonio, TX 78207
Phone (210) 358-3441

7700 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 575-5564

1139 E Sonterra Blvd
San Antonio, TX 78258
Phone (210) 638-2000

333 N Santa Rosa
San Antonio, TX 78207
Phone (210) 704-2190

903 W Martin St
San Antonio, TX 78207
Phone (210) 358-3400

Interoperability endpoints

  • Direct secure messaging: rmcinnerney434186@christushealth.direct-ci.net

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1529798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1205321163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5003",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-309-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-8800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 N Santa Rosa",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782073108",
            "country_code": "US",
            "telephone_number": "210-704-4100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2400 S Avenue A",
            "address_purpose": "LOCATION",
            "city": "Yuma",
            "state": "AZ",
            "postal_code": "853647127",
            "country_code": "US",
            "telephone_number": "928-344-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCINNERNEY",
        "first_name": "ROMAN",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-24",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "T4000",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "T4000",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "AZ",
            "license": "011878",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A17994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.