Active NPI
William Roll
- Clinical Psychologist
- Richmond, IN
National Provider Identifier
1427067297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20010331A
- Practice address
- 831 Dillon Dr
Richmond, IN 47374-8048 - Phone
- (765) 983-8000
- Fax
- (765) 983-8609
- NPI assigned
- Aug 7, 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20010331A | IN | Primary |
Addresses
Primary practice location
831 Dillon Dr
Richmond, IN 47374-8048
Mailing address
645 S Rogers St
Bloomington, IN 47403-2353
Phone (812) 339-1691
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100474840 | Medicaid | IN |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404259200000",
"number": "1427067297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "645 S ROGERS ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474032353",
"telephone_number": "812-339-1691",
"fax_number": "812-337-2438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "831 DILLON DR",
"city": "RICHMOND",
"state": "IN",
"postal_code": "473748048",
"telephone_number": "765-983-8000",
"fax_number": "765-983-8609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLL",
"first_name": "WILLIAM",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-07",
"last_updated": "2014-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20010331A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100474840",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.