Active NPI
Timothy O Roham, DO
- Emergency Medicine Physician
- San Clemente, CA
National Provider Identifier
1518980754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 20A8040
- Practice address
- 629 Camino de Los Mares
Suite # 103
San Clemente, CA 92673-2834 - Phone
- (949) 248-1900
- Fax
- (949) 248-1956
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 20A8040 | CA | Primary |
Addresses
Primary practice location
629 Camino de Los Mares
Suite # 103
San Clemente, CA 92673-2834
Mailing address
629 Camino de Los Mares
Suite # 103
San Clemente, CA 92673-2834
Phone (949) 248-1900
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8040 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| 20A8040 | CA | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229644800000",
"number": "1518980754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "629 CAMINO DE LOS MARES",
"address_2": "SUITE # 103",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "926732834",
"telephone_number": "949-248-1900",
"fax_number": "949-248-1956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "629 CAMINO DE LOS MARES",
"address_2": "SUITE # 103",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "926732834",
"telephone_number": "949-248-1900",
"fax_number": "949-248-1956"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROHAM",
"first_name": "TIMOTHY",
"middle_name": "O",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2008-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CA",
"license": "20A8040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Clemente, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.