Active NPI
Roger Lee Roark, MD
- Surgery Physician
- Statesville, NC
National Provider Identifier
1477596153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 20190
- Practice address
- 555 Kitchings Dr Ste C
Statesville, NC 28677-3576 - Phone
- (704) 873-2516
- NPI assigned
- Jun 13, 2006
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 20190 | NC | Primary |
Addresses
Primary practice location
555 Kitchings Dr Ste C
Statesville, NC 28677-3576
Mailing address
555 Kitchings Dr Ste C
Statesville, NC 28677-3576
Phone (704) 873-2516
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 71981 | Other | NC | BCBS |
| 79 71981 | Medicaid | NC |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20190 | NC | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278028800000",
"number": "1477596153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 KITCHINGS DR STE C",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286773576",
"telephone_number": "704-873-2516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 KITCHINGS DR STE C",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286773576",
"telephone_number": "704-873-2516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROARK",
"first_name": "ROGER",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-13",
"last_updated": "2010-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "20190",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "71981",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "79 71981",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Statesville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.