Individual provider Active NPI

Riley D Rose, AG/ACNP

  • Acute Care Nurse Practitioner
  • Marion, IN
National Provider Identifier
1356776918
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
741004600A Issued in IN
Practice address
1406 W Bella Dr
Marion, IN 46953-5229
Phone
(765) 660-7720
Fax
(765) 662-4493
NPI assigned
Sep 13, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered Nurse 163WW0000X 28161345A IN
Gerontology Nurse Practitioner 363LG0600X 741004600A IN
Acute Care Nurse Practitioner 363LA2100X 741004600A IN Primary

Addresses

Primary practice location

1406 W Bella Dr
Marion, IN 46953-5229

Mailing address

330 N Wabash Ave
Ste G20
Marion, IN 46952-2696
Phone (765) 660-7600

Other identifiers 2

IdentifierTypeStateIssuer
000000878522OtherINANTHEM
201202120AMedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address riley.rose@mgh.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140813002438 IN Practitioner - Nurse Practitioner 6901023092 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marion General HospitalGroup PAC ID 9133023625, 115 clinicians

Practice addresses (Care Compare)

1406 W Bella Dr
Marion, IN 46953-5229
Phone (765) 660-7720

441 N Wabash Ave
Marion, IN 46952-2612
Phone (765) 660-6000

4781 Kaybee Dr
Gas City, IN 46933-6607
Phone (765) 660-7840

Hospital & facility affiliations

  • Marion General Hospital Hospital, Marion, IN, CCN 150011

Merit-based Incentive Payment System (MIPS)

Final score
85.82 of 100Reported as group
Quality
71.45
Promoting interoperability
100
Improvement activities
40
Cost
75.59

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28161345AINMDWound Care Registered Nurse
741004600AINMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Marion General Hospital CurrentSince Jul 28, 2014 Accepting new patients
Marion General Hospital CurrentSince Jul 28, 2014 Accepting new patients

Locations

4781 Kaybee Dr
Gas City, IN 46933
Phone (765) 660-7840

330 N Wabash Ave
Marion, IN 46952
Phone (765) 662-3320

441 N Wabash Ave
Marion, IN 46952
Phone (219) 482-4577

330 N Wabash Ave
Ste G-20
Marion, IN 46952
Phone (765) 660-7600

1406 W Bella Dr
Marion, IN 46953
Phone (765) 660-7470

Organizations & group practices 2

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.

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": "1379030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1356776918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N WABASH AVE",
            "address_2": "STE G20",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522696",
            "telephone_number": "765-660-7600",
            "fax_number": "765-651-7313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 W BELLA DR",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469535229",
            "telephone_number": "765-660-7720",
            "fax_number": "765-662-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "RILEY",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "AG/ACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-13",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "IN",
            "license": "28161345A",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "741004600A",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IN",
            "license": "741004600A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000878522",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201202120A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "riley.rose@mgh.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "1406 W Bella Dr",
            "city": "Marion",
            "state": "IN",
            "country_code": "US",
            "postal_code": "469535229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marion, IN

Sources for this page

Verify at the official NPI Registry.