Jacob Roshanmanesh

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

01081681A Issued in IN

Practice address

620 W Edison Rd Ste 110
Mishawaka, IN 46545-2784

Phone

(574) 258-1100

NPI assigned

Mar 26, 2014

Last updated

Mar 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1427475516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 W EDISON RD STE 110",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452784",
            "telephone_number": "574-258-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W EDISON RD STE 110",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452784",
            "telephone_number": "574-258-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSHANMANESH",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-26",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01081681A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlen Romo
• April Lynn Root, RD
• Anaya Roschyk
• Nicole E Rose
• Amy A Rosen, LMHC
• Roushe Dialysis LLC (Mishawaka Dialysis)
• Steven A. Rowe
• Carol Ann Royer, M.D.
• April Rozycki, FNP-BC
• Todd W Rozycki, MD

• Diagnostic Radiology Physician in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Diagnostic Radiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.