Active NPI
John Roosenberg, M.D.
- Internal Medicine Physician
- Allegan, MI
National Provider Identifier
1508946021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301039017
- Practice address
- 551 Linn St
Suite 110
Allegan, MI 49010-1595 - Phone
- (269) 673-2158
- Fax
- (269) 686-2087
- NPI assigned
- Oct 17, 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301039017 | MI | Primary |
Addresses
Primary practice location
551 Linn St
Suite 110
Allegan, MI 49010-1595
Mailing address
551 Linn St
Suite 110
Allegan, MI 49010-1595
Phone (269) 673-2158
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0030774 | Other | MI | BCBS |
| 2091069 | Medicaid | MI |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481155200000",
"number": "1508946021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "551 LINN ST",
"address_2": "SUITE 110",
"city": "ALLEGAN",
"state": "MI",
"postal_code": "490101595",
"telephone_number": "269-673-2158",
"fax_number": "269-686-2087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "551 LINN ST",
"address_2": "SUITE 110",
"city": "ALLEGAN",
"state": "MI",
"postal_code": "490101595",
"telephone_number": "269-673-2158",
"fax_number": "269-686-2087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROOSENBERG",
"first_name": "JOHN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2016-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301039017",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0030774",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2091069",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Allegan, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.