NPIMap

Individual provider Active NPI

Stacy Dana Roskin, M.D.

  • Family Medicine Physician
  • North Miami Beach, FL
National Provider Identifier
1669530218
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME74069 Issued in FL
Practice address
3435 NE 163Rd St
North Miami Beach, FL 33160-4426
Phone
(786) 480-5707
NPI assigned
Dec 5, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME74069 FL
Family Medicine Physician 207Q00000X ME74069 FL Primary

Addresses

Primary practice location

3435 NE 163Rd St
North Miami Beach, FL 33160-4426

Mailing address

3225 NE 167TH St
North Miami Beach, FL 33160-3847
Phone (786) 480-5705

Other practice location 1

21150 Biscayne Blvd Ste 302
Aventura, FL 33180-1250
Phone (305) 931-0504

Other practice location 2

21150 Biscayne Blvd Ste 302
Aventura, FL 33180-1250
Phone (305) 931-0504

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL eclinical Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20110113000821 FL Practitioner - Internal MedicinePractitioner - Family Practice 1951590488 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
University of Miami, LM Miller School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lifetime Medical Associates of AventuraGroup PAC ID 0143648873, 3 clinicians

Practice addresses (Care Compare)

21097 NE 27TH CT
Suite 300
Aventura, FL 33180-1206
Phone (786) 480-5707

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lifetime Medical Associates of Aventura Internal Medicine CurrentSince Jul 15, 2020 Accepting new patients

Locations

21097 NE 27th Ct
Ste 300
Miami, FL 33180
Phone (786) 244-2700

3435 NE 163rd St
North Miami Beach, FL 33160
Phone (305) 947-3700

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GHIBCD

Organizations & group practices 1

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 9

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": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1669530218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 NE 167TH ST",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331603847",
            "telephone_number": "786-480-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3435 NE 163RD ST",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331604426",
            "telephone_number": "786-480-5707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21150 Biscayne Blvd Ste 302",
            "address_purpose": "LOCATION",
            "city": "Aventura",
            "state": "FL",
            "postal_code": "331801250",
            "country_code": "US",
            "telephone_number": "305-931-0504",
            "fax_number": "305-931-0939",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21150 Biscayne Blvd Ste 302",
            "address_purpose": "LOCATION",
            "city": "Aventura",
            "state": "FL",
            "postal_code": "331801250",
            "country_code": "US",
            "telephone_number": "305-931-0504",
            "fax_number": "305-931-0939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSKIN",
        "first_name": "STACY",
        "middle_name": "DANA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME74069",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME74069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "eclinical",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3435 NE 163rd St",
            "city": "North Miami Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "331604426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in North Miami Beach, FL

Sources for this page

Verify at the official NPI Registry.