Active NPI
Randy Roush
- Peer Specialist
- Sacramento, CA
National Provider Identifier
1205425634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- MPSS-ICZJTE
- Practice address
- 720 Howe Ave
Sacramento, CA 95825-4669 - Phone
- (916) 376-7736
- NPI assigned
- Jan 11, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | |||
| Peer Specialist | 175T00000X | MPSS-ICZJTE | CA | Primary |
Addresses
Primary practice location
720 Howe Ave
Sacramento, CA 95825-4669
Mailing address
3815 Marconi Ave
Sacramento, CA 95821-3867
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MPSS-ICZJTE | CA | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709596800000",
"number": "1205425634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3815 MARCONI AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958213867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 HOWE AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958254669",
"telephone_number": "916-376-7736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUSH",
"first_name": "RANDY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-11",
"last_updated": "2024-03-05",
"certification_date": "2024-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "CA",
"license": "MPSS-ICZJTE",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.