Individual provider Active NPI

Donald Jay Roshan Jr., DO

  • Surgery Physician
  • Rolla, MO
National Provider Identifier
1669039665
Registry record updated Jul 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2024024347 Issued in MO
Practice address
1060 W 10TH St
Rolla, MO 65401-2905
Phone
(855) 406-3324
Fax
(573) 458-8363
NPI assigned
May 24, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2024024347 MO Primary
Student in an Organized Health Care Education/Training Program 390200000X AZ

Addresses

Primary practice location

1060 W 10TH St
Rolla, MO 65401-2905

Mailing address

1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000

Other practice location 1

1301 S Crismon Rd
Mesa, AZ 85209-3767
Phone (480) 373-2370

Other practice location 2

1000 W 10th St
Rolla, MO 65401-2905
Phone (573) 458-8899

Other practice location 3

1000 W 10th St
Rolla, MO 65401-2905
Phone (573) 364-9000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240719002309 MO Practitioner - General Surgery 7618413188 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pcrmc Medical Group IncGroup PAC ID 1557454063, 113 clinicians

Practice addresses (Care Compare)

1060 W 10TH St
Rolla, MO 65401-2905
Phone (855) 406-3324

Hospital & facility affiliations

  • Phelps County Regional Medical Center Hospital, Rolla, MO, CCN 260017

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy42
Hernia repair - groin (open)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux49
Melanoma (skin cancer) excision1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pcrmc Medical Group, Inc CurrentSince Aug 19, 2024 Accepting new patients
Phelps County Regional Medical Center CurrentSince Aug 19, 2024 Accepting new patients
Phelps County Regional Medical Center CurrentSince Aug 19, 2024 Accepting new patients

Locations

1201 Hauck Dr
Rolla, MO 65401
Phone (573) 364-8818

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1060 W 10th St
Rolla, MO 65401
Phone (855) 406-3324

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

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 3

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": "1558656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1669039665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "855-406-3324",
            "fax_number": "573-458-8363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 S Crismon Rd",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852093767",
            "country_code": "US",
            "telephone_number": "480-373-2370",
            "fax_number": "480-373-2375",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-458-8899",
            "fax_number": "573-341-5611",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-364-9000",
            "fax_number": "573-202-2484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSHAN",
        "first_name": "DONALD",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-24",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2024024347",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.