Individual provider Active NPI

Michael S Roura, DC

  • Sports Physician Chiropractor
  • Atlanta, GA
National Provider Identifier
1497296024
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
CHIR009866 Issued in GA
Practice address
3565 Piedmont Rd NE
Building 2, Suite 310
Atlanta, GA 30305-8202
Phone
(404) 352-8900
NPI assigned
Mar 15, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X CHIR009866 GA Primary

Addresses

Primary practice location

3565 Piedmont Rd NE
Building 2, Suite 310
Atlanta, GA 30305-8202

Mailing address

3565 Piedmont Rd NE
Building 2, Suite 310
Atlanta, GA 30305-8202
Phone (404) 352-8900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210923001365 DC Practitioner - Chiropractic 1052718798 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2016
Medicare assignment
May accept Medicare assignment
Group practices
Rxwellness Spine and Health - Herndon Reston LLCGroup PAC ID 8224449103, 6 clinicians

Practice addresses (Care Compare)

950 Herndon Pkwy
Suite 130
Herndon, VA 20170-5526
Phone (703) 904-9666

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIR009866GAMDSports Physician Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Rxwellness Spine & Health - Herndon Reston LLC CurrentSince Aug 1, 2021 Accepting new patients
Synergy Sports Wellness Institute PastSince Sep 27, 2023 Accepting new patients

Locations

950 Herndon Pkwy
Ste 130
Herndon, VA 20170
Phone (703) 272-5402

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1489536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489536000000",
    "number": "1497296024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3565 PIEDMONT RD NE",
            "address_2": "BUILDING 2, SUITE 310",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303058202",
            "telephone_number": "404-352-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3565 PIEDMONT RD NE",
            "address_2": "BUILDING 2, SUITE 310",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303058202",
            "telephone_number": "404-352-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROURA",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-15",
        "last_updated": "2017-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "GA",
            "license": "CHIR009866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.