Individual provider Active NPI

Donald Lee Roegner Jr., M.D.

  • Psychiatry Physician
  • Kokomo, IN
National Provider Identifier
1245364330
Registry record updated Dec 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
01023409A Issued in IN
Practice address
702 West Alto Road
Kokomo, IN 46902
Phone
(765) 453-7422
Fax
(765) 453-3773
NPI assigned
Mar 14, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 01023409A IN Primary

Addresses

Primary practice location

702 West Alto Road
Kokomo, IN 46902

Mailing address

PO Box 6459
Kokomo, IN 46904-6459
Phone (765) 453-7422

Other identifiers 1

IdentifierTypeStateIssuer
100154150AMedicaidIN

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mending Minds, LLC Psychiatry PastSince Mar 1, 2022 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24167/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354492800000",
    "number": "1245364330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6459",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469046459",
            "telephone_number": "765-453-7422",
            "fax_number": "765-453-3773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 WEST ALTO ROAD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "46902",
            "telephone_number": "765-453-7422",
            "fax_number": "765-453-3773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROEGNER",
        "first_name": "DONALD",
        "middle_name": "LEE",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2012-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01023409A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100154150A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.

Verify at the official NPI Registry.