Individual provider Active NPI

Richard Allen Roller, MD, PHD

  • General Practice Physician
  • Enterprise, AL
National Provider Identifier
1487610564
Registry record updated Nov 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
29971 Issued in AL
Practice address
805 E Lee St
Suite C
Enterprise, AL 36330-2368
Phone
(334) 348-8818
Fax
(334) 393-8773
NPI assigned
Apr 26, 2006
Last updated
Nov 20, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X 29971 AL
Aerospace Medicine Physician 2083A0100X 29971 AL
General Practice Physician 208D00000X 29971 AL Primary

Addresses

Primary practice location

805 E Lee St
Suite C
Enterprise, AL 36330-2368

Mailing address

805 E Lee St
Suite C
Enterprise, AL 36330-2368
Phone (334) 348-8818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120820000741 AL Practitioner - Family PracticePractitioner - Preventive Medicine 0042467441 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Contracting Services LLC CurrentSince Jul 1, 2012 Accepting new patients
Andalusia Physician Practices LLC CurrentSince May 28, 2013 Accepting new patients
Andalusia Physician Practices LLC CurrentSince May 28, 2013 Accepting new patients
Andalusia Physician Practices LLC Current Accepting new patients
Southern Alabama Physicians LLP CurrentSince Nov 1, 2015 Accepting new patients
Enterprise Clinic LLC CurrentSince Oct 1, 2015 Accepting new patients
Southern Alabama Physicians,LLP CurrentSince Nov 1, 2015 Accepting new patients
Inphynet Contracting Services LLC Past Accepting new patients
Andalusia Professional Services LLC Past Accepting new patients

Locations

301 Medical Ave
Ste C
Andalusia, AL 36420
Phone (334) 222-1211

849 S Three Notch St
Andalusia, AL 36420
Phone (334) 222-8466

810 Saint Vincents Dr
Birmingham, AL 35205
Phone (205) 930-2456

4370 W Main St
Dothan, AL 36305
Phone (256) 332-1611

101 E Brunson St
Ste 110
Enterprise, AL 36330
Phone (334) 347-9355

400 N Edwards St
Enterprise, AL 36330
Phone (334) 347-0584

805 E Lee St
Ste C
Enterprise, AL 36330
Phone (334) 348-8818

75 Remit Dr
Chicago, IL 60675

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19364/brand/1/csg/21/fhir/r4

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447977600000",
    "number": "1487610564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 E LEE ST",
            "address_2": "SUITE C",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302368",
            "telephone_number": "334-348-8818",
            "fax_number": "334-393-8773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 E LEE ST",
            "address_2": "SUITE C",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302368",
            "telephone_number": "334-348-8818",
            "fax_number": "334-393-8773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLLER",
        "first_name": "RICHARD",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2015-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AL",
            "license": "29971",
            "primary": false
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "AL",
            "license": "29971",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AL",
            "license": "29971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enterprise, AL

Sources for this page

Verify at the official NPI Registry.