NPIMap

Individual provider Active NPI

Melissa M Roesly, M.D.

  • Family Medicine Physician
  • Medford, NJ
National Provider Identifier
1649250846
Registry record updated Oct 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MA06357100 Issued in NJ
Practice address
103 Old Marlton Pike
Suite 111
Medford, NJ 08055-8772
Phone
(609) 953-7111
Fax
(609) 953-1544
NPI assigned
Jan 23, 2006
Last updated
Oct 18, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MA06357100 NJ Primary

Addresses

Primary practice location

103 Old Marlton Pike
Suite 111
Medford, NJ 08055-8772

Mailing address

401 Route 73 N
40 Lake Center Drive Suite 201a
Marlton, NJ 08053-3425
Phone (856) 355-0340

Other identifiers 1

IdentifierTypeStateIssuer
7468806MedicaidNJ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mroesly14010@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20100222000583 NJ Practitioner - Family Practice 7810031390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

128 Route 70
Medford, NJ 08055-2371

3242 Route 206
Bordentown, NJ 08505-4517

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA Family Medicine Current Accepting new patients
Virtua Medical Group, PA CurrentSince Jul 1, 2010 Accepting new patients
Virtua - West Jersey Health System, Inc. Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

303 Lippincott Dr
Marlton, NJ 08053

534 Lippincott Dr
Marlton, NJ 08053
Phone (856) 985-7373

103 Old Marlton Pike
Ste 111
Medford, NJ 08055
Phone (609) 451-8088

Interoperability endpoints

  • Direct secure messaging: mroesly14010@directvirtua.org

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.

Hospital & facility affiliations 12

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": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602979200000",
    "number": "1649250846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 ROUTE 73 N",
            "address_2": "40 LAKE CENTER DRIVE SUITE 201A",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533425",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 OLD MARLTON PIKE",
            "address_2": "SUITE 111",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080558772",
            "telephone_number": "609-953-7111",
            "fax_number": "609-953-1544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROESLY",
        "first_name": "MELISSA",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-23",
        "last_updated": "2020-10-18",
        "certification_date": "2020-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA06357100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7468806",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mroesly14010@directvirtua.org",
            "affiliation": "N",
            "address_1": "103 Old Marlton Pike",
            "address_2": "Suite 111",
            "city": "Medford",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080558772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, NJ

Sources for this page

Verify at the official NPI Registry.