NPIMap

Individual provider Active NPI

Wilbur Ray Roese, M.D.

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1588764278
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0045789 Issued in MD
Practice address
4701 Fullerton Ave
Baltimore, MD 21236-4619
Phone
(410) 661-7676
Fax
(410) 661-3266
NPI assigned
Sep 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0045789 MD Primary

Addresses

Primary practice location

4701 Fullerton Ave
Baltimore, MD 21236-4619

Mailing address

4701 Fullerton Ave
Baltimore, MD 21236-4619
Phone (410) 661-7676

Other identifiers 1

IdentifierTypeStateIssuer
4105338 00MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110223000942 MD Practitioner - Internal Medicine 7214118272 Reassigns benefits to 1 organization
Practice locations: Baltimore, MD

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Maryland School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

1406 Crain S Hwy 106
Glen Burnie, MD 21061-4086
Phone (410) 768-6440

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0045789MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Dec 27, 2015 Accepting new patients
Medstar Medical Group II LLC Internal Medicine CurrentSince Dec 27, 2015 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5601 Loch Raven Blvd
Ste 102
Baltimore, MD 21239
Phone (410) 581-1200

1406 Crain Hwy S
Glen Burnie, MD 21061
Phone (410) 768-6440

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

9106 Philadelphia Rd
Rosedale, MD 21237
Phone (410) 294-3884

Organizations & group practices 3

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630281600000",
    "number": "1588764278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 FULLERTON AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212364619",
            "telephone_number": "410-661-7676",
            "fax_number": "410-661-3266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 FULLERTON AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212364619",
            "telephone_number": "410-661-7676",
            "fax_number": "410-661-3266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROESE",
        "first_name": "WILBUR",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0045789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4105338 00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.