Active NPI
Jessica Roman, RD
- Registered Dietitian
- Bloomington, IN
National Provider Identifier
1306216437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86052599
- Practice address
- 1136 W 17TH St
Ste. B
Bloomington, IN 47404-3002 - Phone
- (260) 227-1174
- NPI assigned
- Oct 1, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86052599 | IN | Primary |
Addresses
Primary practice location
1136 W 17TH St
Ste. B
Bloomington, IN 47404-3002
Mailing address
3213 S Walnut Springs Dr
Bloomington, IN 47401-7424
Phone (260) 227-1174
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86052599 | IN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443657600000",
"number": "1306216437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3213 S WALNUT SPRINGS DR",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474017424",
"telephone_number": "260-227-1174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1136 W 17TH ST",
"address_2": "STE. B",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474043002",
"telephone_number": "260-227-1174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROMAN",
"first_name": "JESSICA",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-01",
"last_updated": "2015-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IN",
"license": "86052599",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.