Individual provider Active NPI

Pauline Blaise Roxas, MD

  • Student in an Organized Health Care Education/Training Program
  • Philadelphia, PA
National Provider Identifier
1558064204
Registry record updated Jul 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
25 S 9TH St FL 1
Philadelphia, PA 19107-4408
Phone
(215) 606-4888
Fax
(215) 923-6808
NPI assigned
Mar 22, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X W2775 TX
Spinal Cord Injury Medicine Physician 2081P0004X MT237069 PA
Student in an Organized Health Care Education/Training Program 390200000X PA Primary

Addresses

Primary practice location

25 S 9TH St FL 1
Philadelphia, PA 19107-4408

Mailing address

25 S 9TH St FL 1
Philadelphia, PA 19107-4408
Phone (215) 606-4888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Citizens Medical Center County of Victoria Past Accepting new patients

Organizations & group practices 1

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": "1679443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1558064204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 S 9TH ST FL 1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074408",
            "telephone_number": "215-606-4888",
            "fax_number": "215-923-6808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 S 9TH ST FL 1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074408",
            "telephone_number": "215-606-4888",
            "fax_number": "215-923-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROXAS",
        "first_name": "PAULINE",
        "middle_name": "BLAISE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-22",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "W2775",
            "primary": false
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "PA",
            "license": "MT237069",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.