NPIMap

Individual provider Active NPI

Kevin Jay Roscoe, M.D.

  • Diagnostic Radiology Physician
  • Olympia, WA
National Provider Identifier
1407931793
Registry record updated Mar 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD00036887 Issued in WA
Practice address
3417 Ensign Rd NE
Olympia, WA 98506-5075
Phone
(360) 493-4600
Fax
(360) 493-4603
NPI assigned
Oct 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD00036887 WA Primary

Addresses

Primary practice location

3417 Ensign Rd NE
Olympia, WA 98506-5075

Mailing address

3417 Ensign Rd NE
Olympia, WA 98506-5075
Phone (360) 493-4600

Other identifiers 1

IdentifierTypeStateIssuer
8516817MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20080612000337 WA Practitioner - Diagnostic RadiologyPractitioner - Family Practice 3577634989 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Family Practice
Education
Albany Medical College of Union University, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radia Inc P SGroup PAC ID 9931012812, 275 clinicians
South Sound Radiologists Inc P SGroup PAC ID 1254229305, 76 clinicians

Practice addresses (Care Compare)

12040 NE 128TH St
Kirkland, WA 98034-3013
Phone (425) 899-1800

3417 Ensign Rd NE
Olympia, WA 98506-5064
Phone (360) 493-4600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
30.1 of 100Reported as individual
Quality
17.76
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Radia Imaging Center Holdings LLC Diagnostic Radiology CurrentSince Jan 1, 2019 Accepting new patients
Radia Imaging Center Holdings LLC Diagnostic Radiology CurrentSince Jan 1, 2019 Accepting new patients
Radia Inc P S Diagnostic Radiology CurrentSince Jan 1, 2018 Accepting new patients
Evergreen Radia LLC Diagnostic Radiology CurrentSince Sep 18, 2019 Accepting new patients
Swedish Radia Imaging Center at Edmonds LLC Diagnostic Radiology CurrentSince Sep 18, 2019 Accepting new patients

Locations

21700 Highway 99
Edmonds, WA 98026
Phone (425) 640-4949

11521 NE 128th St
Ste 200
Kirkland, WA 98034
Phone (425) 952-6100

12040 NE 128th St
Kirkland, WA 98034
Phone (425) 899-1000

19020 33rd Ave W
Ste 210
Lynnwood, WA 98036
Phone 42556315001

1025 153rd St SE
Ste 200
Mill Creek, WA 98012
Phone (425) 338-4000

3417 Ensign Rd NE
Olympia, WA 98506
Phone (360) 493-4600

3900 Capital Mall Dr SW
Olympia, WA 98502
Phone (360) 704-4743

500 17th Ave
Seattle, WA 98122
Phone (206) 320-2111

1229 Madison St
Ste 900
Seattle, WA 98104
Phone (206) 292-6233

4816 NE Thurston Way
Ste A
Vancouver, WA 98662
Phone (360) 254-4914

Organizations & group practices 6

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": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269302400000",
    "number": "1407931793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3417 ENSIGN RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065075",
            "telephone_number": "360-493-4600",
            "fax_number": "360-493-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 ENSIGN RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065075",
            "telephone_number": "360-493-4600",
            "fax_number": "360-493-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSCOE",
        "first_name": "KEVIN",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2010-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD00036887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8516817",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.