NPIMap

Individual provider Active NPI

George Roque, M.D.

  • Internal Medicine Physician
  • West Melbourne, FL
National Provider Identifier
1376505834
Registry record updated Aug 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME88828 Issued in FL
Practice address
1541 S Wickham Rd
West Melbourne, FL 32904-3540
Phone
(321) 726-6331
Fax
(321) 726-6371
NPI assigned
Apr 3, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME88828 FL Primary

Addresses

Primary practice location

1541 S Wickham Rd
West Melbourne, FL 32904-3540

Mailing address

1541 S Wickham Rd
West Melbourne, FL 32904-3540
Phone (321) 254-1220

Other identifiers 15

IdentifierTypeStateIssuer
P00196213OtherRAILROAD MEDICARE #
10024OtherFLORIDANCARE PROVIDER #
246370OtherWELLCARE MCAID PROVIDER #
9303692OtherCIGNA PROVIDER #
201388186OtherUNITED HEALTHCARE #
201388186OtherHEALTH FIRST PROVIDER #
201388186OtherHUMANA PROVIDER #
6691200001OtherFLMEDICARE DME
7274610OtherAETNA PROVIDER #
201388186OtherTRICARE PROVIDER #
270958900MedicaidFL
5585831OtherCCN NETWORK PROVIDER #
37972OtherBCBS PROVIDER #
9362860OtherPHCS PROVIDER #
1809978OtherFIRST HEALTH PROVIDER#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040811000290 FL Practitioner - Internal Medicine 6709858681 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1541 S Wickham Rd
West Melbourne, FL 32904-3540
Phone (321) 726-6331

Hospital & facility affiliations

  • Concierge Home Care Home health agency, Melbourne, FL, CCN 687040
  • Health First Home Care Home health agency, Melbourne, FL, CCN 107233
  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
  • Orlando Health Melbourne Hospital Hospital, Melbourne, FL, CCN 100291
  • Holmes Regional Medical Center Hospital, Melbourne, FL, CCN 100019
  • Viera Hospital Hospital, Melbourne, FL, CCN 100315

Merit-based Incentive Payment System (MIPS)

Final score
92.42 of 100Reported as individual
Quality
84.83
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Atlantic Medical Group Internal Medicine CurrentSince Jun 24, 2004 Accepting new patients

Locations

3040 N Wickham Rd
Ste 6
Melbourne, FL 32935
Phone (321) 226-8607

1541 S Wickham Rd
West Melbourne, FL 32904
Phone (321) 725-8300

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: george.roque.1@2460.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/2460/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.

Hospital & facility affiliations 10

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": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345680000000",
    "number": "1376505834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 S WICKHAM RD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329043540",
            "telephone_number": "321-254-1220",
            "fax_number": "321-254-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 S WICKHAM RD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329043540",
            "telephone_number": "321-726-6331",
            "fax_number": "321-726-6371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROQUE",
        "first_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-03",
        "last_updated": "2012-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME88828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE #",
            "identifier": "P00196213",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDANCARE PROVIDER #",
            "identifier": "10024",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE MCAID PROVIDER #",
            "identifier": "246370",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PROVIDER #",
            "identifier": "9303692",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE #",
            "identifier": "201388186",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH FIRST PROVIDER #",
            "identifier": "201388186",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA PROVIDER #",
            "identifier": "201388186",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "6691200001",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER #",
            "identifier": "7274610",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE PROVIDER #",
            "identifier": "201388186",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270958900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN NETWORK PROVIDER #",
            "identifier": "5585831",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "37972",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS PROVIDER #",
            "identifier": "9362860",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH PROVIDER#",
            "identifier": "1809978",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Melbourne, FL

Sources for this page

Verify at the official NPI Registry.