Active NPI
David Bertrand Rose, P.A.
- Surgical Physician Assistant
- Greenwood, IN
National Provider Identifier
1477536530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 1001247
- Practice address
- 369 Euclid Ave
Greenwood, IN 46142-3613 - Phone
- (317) 881-2958
- NPI assigned
- Nov 22, 2005
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 1001247 | GA | Primary |
Addresses
Primary practice location
369 Euclid Ave
Greenwood, IN 46142-3613
Mailing address
CMR 427, Box 2221
Vicenza, VENETO APO AE 09630
IT
Phone 011390444583299
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001247 | GA | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370390400000",
"number": "1477536530",
"addresses": [
{
"country_code": "IT",
"country_name": "Italy",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "CMR 427, BOX 2221",
"city": "VICENZA",
"state": "VENETO",
"postal_code": "APO AE 09630",
"telephone_number": "011390444583299",
"fax_number": "011390444718210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "369 EUCLID AVE",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461423613",
"telephone_number": "317-881-2958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "DAVID",
"middle_name": "BERTRAND",
"name_prefix": "Mr.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-22",
"last_updated": "2013-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "GA",
"license": "1001247",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.