Active NPI
Thomas Paul Roeder, D.D.S.
- Dentist
- Berkeley, CA
National Provider Identifier
1265558795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 20448
- Practice address
- 914 The Alameda
Berkeley, CA 94707-2308 - Phone
- (510) 526-1411
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 20448 | CA | Primary |
Addresses
Primary practice location
914 The Alameda
Berkeley, CA 94707-2308
Mailing address
98 Deer Park Ave
San Rafael, CA 94901-2312
Phone (415) 453-0484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 11, 2015 through Mar 11, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20448 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265558795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "98 DEER PARK AVE",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949012312",
"telephone_number": "415-453-0484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "914 THE ALAMEDA",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947072308",
"telephone_number": "510-526-1411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROEDER",
"first_name": "THOMAS",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "20448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.