Active NPI
Paul Kirk Roden
- Physician Assistant
- Sharon, PA
National Provider Identifier
1619522810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-997
- Practice address
- 740 E State St
Sharon, PA 16146-3328 - Phone
- (724) 983-3912
- NPI assigned
- Aug 5, 2019
- Last updated
- Sep 10, 2021
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-997 | AR | Primary |
| Medical Physician Assistant | 363AM0700X | MA062331 | PA | |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
740 E State St
Sharon, PA 16146-3328
Mailing address
199 Case Ave
Sharon, PA 16146-3464
Phone (405) 549-3984
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-997 | AR | MD | Physician Assistant |
| MA062331 | PA | MD | Medical Physician Assistant |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631232000000",
"number": "1619522810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "199 CASE AVE",
"city": "SHARON",
"state": "PA",
"postal_code": "161463464",
"telephone_number": "405-549-3984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "740 E STATE ST",
"city": "SHARON",
"state": "PA",
"postal_code": "161463328",
"telephone_number": "724-983-3912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODEN",
"first_name": "PAUL",
"middle_name": "KIRK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-05",
"last_updated": "2021-09-10",
"certification_date": "2021-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AR",
"license": "PA-997",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA062331",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sharon, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.