Active NPI
Roger Depra, M.D.
- Family Medicine Physician
- Spartanburg, SC
National Provider Identifier
1386750370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- LL 29091
- Practice address
- 853 N Church St
Suite 510
Spartanburg, SC 29303-3098 - Phone
- (864) 560-6193
- Fax
- (864) 560-1510
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | LL 29091 | SC | Primary |
Addresses
Primary practice location
853 N Church St
Suite 510
Spartanburg, SC 29303-3098
Mailing address
727 Brimstone LN
Spartanburg, SC 29301-5040
Phone (864) 587-1886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201112000140 | SC | Order and Referring Only - Family Practice | 9638347677 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL 29091 | SC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386750370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "727 BRIMSTONE LN",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293015040",
"telephone_number": "864-587-1886",
"fax_number": "864-587-1886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "853 N CHURCH ST",
"address_2": "SUITE 510",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293033098",
"telephone_number": "864-560-6193",
"fax_number": "864-560-1510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEPRA",
"first_name": "ROGER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "LL 29091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.