NPIMap

Individual provider Active NPI

Keith A Roller, MD

  • Anesthesiology Physician
  • Boardman, OH
National Provider Identifier
1629012950
Registry record updated May 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
35058177 Issued in OH
Practice address
8401 Market St
Boardman, OH 44512-6725
Phone
(330) 286-5330
Fax
(330) 286-5396
NPI assigned
Jun 16, 2006
Last updated
May 3, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 35058177 OH Primary

Addresses

Primary practice location

8401 Market St
Boardman, OH 44512-6725

Mailing address

4135 Boardman Canfield Rd
Suite 101
Canfield, OH 44406-9803
Phone (330) 286-5330

Other identifiers 6

IdentifierTypeStateIssuer
P01200681OtherOHMEDICARE RAILROAD
2600242MedicaidOH
000000811586OtherOHANTHEM BCBS
10896526OtherCAQH
H011682OtherOHMEDICARE PTAN
1028247410001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20050921000771 OH Practitioner - Anesthesiology 8921907304 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Northeastern Ohio University College of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bel-Park Anesthesia Associates, Inc.Group PAC ID 8628974904, 158 clinicians

Practice addresses (Care Compare)

8401 Market St
Boardman, OH 44512-6725
Phone (330) 729-1556

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35058177OHMDAnesthesiology Physician
000300MOMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Ohio LLC Anesthesiology CurrentSince Nov 12, 2012 Accepting new patients
Bel-Park Anesthesia Associates, Inc. Anesthesiology CurrentSince Apr 1, 2013 Accepting new patients
Anesthesia Consultants of Oxford, PLLC Past Accepting new patients
Anesthesia Consultants of Pettis County, PC Anesthesiology PastSince Jan 5, 2004 Accepting new patients
Rural Anesthesia Management, LLC Anesthesiology Past Accepting new patients
Ozark Anesthesia Associates, Inc. Anesthesiology PastSince Jun 17, 2002 Accepting new patients
Coble Eye Associates,P.a. Past Accepting new patients

Locations

4135 Boardman Canfield Rd
Ste 101
Canfield, OH 44406
Phone (330) 532-7215

2615 E High St
Springfield, OH 45505
Phone (888) 861-3994

3893 E Market St
Warren, OH 44484
Phone (330) 856-4000

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

8401 Market St
Youngstown, OH 44512
Phone (330) 729-2929

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1629012950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4135 BOARDMAN CANFIELD RD",
            "address_2": "SUITE 101",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069803",
            "telephone_number": "330-286-5330",
            "fax_number": "330-286-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MARKET ST",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126725",
            "telephone_number": "330-286-5330",
            "fax_number": "330-286-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLLER",
        "first_name": "KEITH",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "35058177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P01200681",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2600242",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000811586",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "10896526",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H011682",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028247410001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.