Brian Charles Roach, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G 035559 Issued in CA

Practice address

1720 El Camino Real
Suite 160
Burlingame, CA 94010-3224

Phone

(650) 259-9480

Fax

(650) 259-1428

NPI assigned

Aug 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Mills-Peninsula Medical Group

  • General Practice Physician
  • Burlingame, CA
  • NPI 1639384274
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215940887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "577 AIRPORT BLVD",
            "address_2": "SUITE 300",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940102020",
            "telephone_number": "650-240-8040",
            "fax_number": "650-348-9060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 EL CAMINO REAL",
            "address_2": "SUITE 160",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940103224",
            "telephone_number": "650-259-9480",
            "fax_number": "650-259-1428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "BRIAN",
        "middle_name": "CHARLES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G 035559",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "G035559",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nell B. Riley, PH.D.
• Mary Rippel, MS, CCC-SLP
• Rise Within Therapy Studio Licensed Clinical Social Worker Services Inc
• Melanie Marie Rivas
• Veronica Rivera
• Robert R. Elliston, M.D.
• Roberto Diaz, M.D.
• Katherine Robertson, PSY.D.
• Nina Robin
• Hilary Kate Robison, LCSW

• Internal Medicine Physician in Burlingame, CA
• Providers in Burlingame, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.