Individual provider Active NPI

Michael J. Roselman, MD

  • Cardiovascular Disease Physician
  • Springfield, MO
National Provider Identifier
1609965524
Registry record updated Jun 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
R5B17 Issued in MO
Practice address
2115 S Fremont Ave
Suite 4300
Springfield, MO 65804-2239
Phone
(417) 820-3911
Fax
(417) 820-3924
NPI assigned
Oct 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X R5B17 MO Primary

Addresses

Primary practice location

2115 S Fremont Ave
Suite 4300
Springfield, MO 65804-2239

Mailing address

PO Box 505164
Saint Louis, MO 63150-5164
Phone (417) 820-2000

Other identifiers 1

IdentifierTypeStateIssuer
202449328MedicaidMO

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 Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ozarks Medical Center Past Accepting new patients
Mercy Clinic Cardiovascular and Thoracic Surgery, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mroselman957@directb.mercy.net

Organizations & group practices 2

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": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434326400000",
    "number": "1609965524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505164",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631505164",
            "telephone_number": "417-820-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 S FREMONT AVE",
            "address_2": "SUITE 4300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042239",
            "telephone_number": "417-820-3911",
            "fax_number": "417-820-3924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSELMAN",
        "first_name": "MICHAEL",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2015-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "R5B17",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202449328",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.