NPIMap

Individual provider Active NPI

Roger D Gallant, MD

  • Family Medicine Physician
  • Elizabeth City, NC
National Provider Identifier
1215077102
Registry record updated Mar 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C54770 Issued in CA
Practice address
1144 N Road St
Elizabeth City, NC 27909-3353
Phone
(330) 493-4443
NPI assigned
Feb 8, 2007
Last updated
Mar 23, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 200300979 NC
Family Medicine Physician 207Q00000X C54770 CA Primary

Addresses

Primary practice location

1144 N Road St
Elizabeth City, NC 27909-3353

Mailing address

4535 Dressler Rd NW
Canton, OH 44718-2545
Phone (330) 493-4443

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110826000451 CA Practitioner - Emergency Medicine 4486557253 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Loma Linda University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Newstart Medical Group IncGroup PAC ID 8628299799, 22 clinicians

Practice addresses (Care Compare)

20601 W Paoli LN
Weimar, CA 95736-0486
Phone (530) 637-4025

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200300979NCMDEmergency Medicine Physician
C54770CAMDFamily Medicine Physician
00979NCMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Newstart Medical Group Inc CurrentSince Nov 1, 2014 Accepting new patients
Emergency Medicine Physicians of Ohio County, PLLC Emergency Medicine Past Accepting new patients
North Carolina Em I Medical Services P C Past Accepting new patients
Waterway Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Stallant Medical Group Inc PastSince Nov 7, 2019 Accepting new patients
Emergency Medicine Physicians of Belmont County LTD Emergency Medicine Past Accepting new patients
Central California Radiology Associates Inc Past Accepting new patients
Sierra Rural Physicians, Inc. Emergency Medicine Past Accepting new patients
Marshall Medical Center Past Accepting new patients

Locations

20601 Paoli Ln
Colfax, CA 95713
Phone (530) 637-4025

Interoperability endpoints

  • Direct secure messaging: roger.gallant.1@11511.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Blue Stone Health & WellnessWeimar, CA, CCN 058987 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer (100%)
Corporate Director (100%)
W-2 Managing Employee		 Jul 21, 2014
Jul 21, 2014
Jul 21, 2014
Apr 17, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Newstart Medical Group Inc

    dba Blue Stone Health and Wellness

    • Rural Health Clinic/Center
    • Weimar, CA
    • NPI 1588072698

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490227200000",
    "number": "1215077102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182545",
            "telephone_number": "330-493-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1144 N ROAD ST",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279093353",
            "telephone_number": "330-493-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLANT",
        "first_name": "ROGER",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2017-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "200300979",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C54770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth City, NC

Sources for this page

Verify at the official NPI Registry.