Mark David Roman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9101641 Issued in FL

Practice address

225 Mary Wallace Way
Dallas, GA 30157-5054

Phone

(770) 608-3302

NPI assigned

Jun 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MT, TX, AK3 enrollments

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mroman823356@wm.providencedirect.org

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.

• Memorial Hospital Association

  • Primary Care Clinic/Center
  • Red Lodge, MT
  • NPI 1184785099
  Medicare reassignment NPD
• Missoula Community Health Services, Inc.

  • Critical Access Hospital
  • Superior, MT
  • NPI 1902990005
  Medicare reassignment NPD
• Municipality of Skagway

  • Federally Qualified Health Center (FQHC)
  • Skagway, AK
  • NPI 1063574200
  Medicare reassignment NPD
• Norton Sound Health Corporation

  • Critical Access Hospital
  • Nome, AK
  • NPI 1154358232

  Physician Assistant

  Medicare reassignment NPD
• Plains Hospital Corporation

  • Critical Access Hospital
  • Plains, MT
  • NPI 1265547939
  Medicare reassignment NPD
• Tanana Chiefs Conference

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1821201278

  TX

  Medicare reassignment NPD
• Liberty County Hospital and Nursing Home, Inc

  • Rural Health Clinic/Center
  • Chester, MT
  • NPI 1003984097
  Medicare reassignment
• Logan Health - Conrad

  • Critical Access Hospital
  • Conrad, MT
  • NPI 1467445049
  Medicare reassignment
• Missoula Community Health Services, Inc

  • General Practice Physician
  • Superior, MT
  • NPI 1710165105
  Medicare reassignment
• Southeast Alaska Regional Health Consortium

  • Clinic/Center
  • Thorne Bay, AK
  • NPI 1376758037

  TX

  Medicare reassignment
• Townsend Health Systems, Inc.

  • Critical Access Hospital
  • Townsend, MT
  • NPI 1447245857
  Medicare reassignment
• Logan Health - Conrad

  • Rural Health Clinic/Center
  • Conrad, MT
  • NPI 1669461703
  NPD

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534118400000",
    "number": "1588692602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 KRUGER RD",
            "city": "PLAINS",
            "state": "MT",
            "postal_code": "598599271",
            "telephone_number": "406-826-4800",
            "fax_number": "406-826-4811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MARY WALLACE WAY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301575054",
            "telephone_number": "770-608-3302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMAN",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2018-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291095100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey Robinson, M.S.
• Lirqui Y Rodriquez-Aparicio
• Elizabeth Ann Roethke, M.A.
• Rogue Sun Counseling & Consulting, LLC
• Valerie Jean Rohde, DONA
• Robin Seay Romick, LPC
• Heidi Roscoe
• Rosemills Counseling and Consulting Services, LLC
• Kenneth Rowell, CAC II
• Natalie Rowell, NP

• Physician Assistant in Dallas, GA
• Providers in Dallas, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.