Active NPI
Roger Back
- Registered Nurse
- Vandalia, OH
National Provider Identifier
1457592297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 304720
- Practice address
- 37 N Brown School Rd
Vandalia, OH 45377-2826 - Phone
- (937) 520-4803
- NPI assigned
- Mar 6, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 304720 | OH | Primary |
Addresses
Primary practice location
37 N Brown School Rd
Vandalia, OH 45377-2826
Mailing address
37 N Brown School Rd
Vandalia, OH 45377-2826
Phone (937) 520-4803
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 304720 | OH | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236297600000",
"number": "1457592297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 N BROWN SCHOOL RD",
"city": "VANDALIA",
"state": "OH",
"postal_code": "453772826",
"telephone_number": "937-520-4803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37 N BROWN SCHOOL RD",
"city": "VANDALIA",
"state": "OH",
"postal_code": "453772826",
"telephone_number": "937-520-4803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACK",
"first_name": "ROGER",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-03-06",
"last_updated": "2009-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "304720",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vandalia, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.