Active NPI
Douglas A Roise, MD
- Clinical Pathology/Laboratory Medicine Physician
- Fargo, ND
National Provider Identifier
1205854080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Pathology/Laboratory Medicine Physician
- License
- 4957
- Practice address
- 1702 University Dr S
Fargo, ND 58103-4940 - Phone
- (701) 364-3300
- Fax
- (701) 364-8906
- NPI assigned
- Jul 18, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Pathology/Laboratory Medicine Physician | 207ZP0105X | 4957 | ND | Primary |
Addresses
Primary practice location
1702 University Dr S
Fargo, ND 58103-4940
Mailing address
PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142059 | Other | ND | UCARE # |
| 14544 | Medicaid | ND | |
| 12352 | Other | ND | SIOUX VALLEY # |
| 88D16RO | Other | ND | FGO MNBS# |
| HP38337 | Other | ND | HEALTHPARTNERS # |
| 1100119 | Other | ND | FGO MEDICA # |
| 17475 | Medicaid | ND | |
| 1012767 | Other | ND | ARAZ # |
| 19107 | Other | ND | FGO NDBS # |
| DA9011026994 | Other | ND | PREF 1 # |
| 1100125 | Other | ND | INN MEDICA # |
| 213627900 | Medicaid | ND |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4957 | ND | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342569600000",
"number": "1205854080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6001",
"city": "FARGO",
"state": "ND",
"postal_code": "581086001",
"telephone_number": "701-364-3300",
"fax_number": "701-364-8906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1702 UNIVERSITY DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581034940",
"telephone_number": "701-364-3300",
"fax_number": "701-364-8906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROISE",
"first_name": "DOUGLAS",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2012-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0105X",
"taxonomy_group": "",
"desc": "Pathology, Clinical Pathology/Laboratory Medicine",
"state": "ND",
"license": "4957",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE #",
"identifier": "142059",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "14544",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIOUX VALLEY #",
"identifier": "12352",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FGO MNBS#",
"identifier": "88D16RO",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS #",
"identifier": "HP38337",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FGO MEDICA #",
"identifier": "1100119",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "17475",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ #",
"identifier": "1012767",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FGO NDBS #",
"identifier": "19107",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREF 1 #",
"identifier": "DA9011026994",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INN MEDICA #",
"identifier": "1100125",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "213627900",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.