Kyle David Roseberry

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

01085375A Issued in IN

Practice address

355 W 16TH St
Indianapolis, IN 46202-2207

Phone

(317) 963-7307

NPI assigned

Apr 11, 2019

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Deaconess Memorial Medical Center Inc

  • Emergency Medicine Physician
  • Huntingburg, IN
  • NPI 1114120128
  NPD
• Deaconess Memorial Medical Center Inc

  • Pain Medicine Physician
  • Jasper, IN
  • NPI 1457164543
  NPD
• Deaconess Memorial Medical Center Inc

  • Hospitalist Physician
  • Jasper, IN
  • NPI 1588778518
  NPD

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1497218903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7249 ARBUCKLE CMNS APT 103",
            "city": "BROWNSBURG",
            "state": "IN",
            "postal_code": "461121478",
            "telephone_number": "317-657-4891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 W 16TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022207",
            "telephone_number": "317-963-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSEBERRY",
        "first_name": "KYLE",
        "middle_name": "DAVID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-11",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01085375A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael E Rose, LCSW
• Rebecca Susan Rose, MD
• Susan P Rose, MD
• Talisha Marie Rose
• Rose'S Comfort LLC
• Ty Martin Roseberry, PA
• Evann Rae Rosebrough, CLC
• Ryan Matthew Rosebrough, MPAS, PA-C
• Rosebud Personal Service Agency
• Stephen Antatico Rosell

• Psychiatry Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.