NPIMap

Organization Active NPI

Roanoke Family Medicine Inc

  • Family Medicine Physician
  • Roanoke, VA
National Provider Identifier
1508963794
Registry record updated Nov 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ROANOKE FAMILY MEDICINE INC
Practice address
3990 Colonial Ave
Roanoke, VA 24018-3740
Phone
(540) 772-1006
Fax
(540) 772-1086
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2014

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

Authorized official

Name
Mr. Edward L Wilkes
Title
President
Phone
(540) 721-1006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3990 Colonial Ave
Roanoke, VA 24018-3740

Mailing address

PO Box 4127
Roanoke, VA 24015-0127
Phone (540) 981-9394

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050105000743 VA Part B Supplier - Clinic/Group Practice 4486602596 Receives reassigned benefits from 6 practitioners
Practice locations: Roanoke, VA; Salem, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1508963794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4127",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240150127",
            "telephone_number": "540-981-9394",
            "fax_number": "540-344-7154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 COLONIAL AVE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240183740",
            "telephone_number": "540-772-1006",
            "fax_number": "540-772-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANOKE FAMILY MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "WILKES",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-721-1006",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.