Active NPI
Joan Widman Roux, MD
- Pediatrics Physician
- Oakland, CA
National Provider Identifier
1679602163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A79291
- Practice address
- 747 52ND St
Oakland, CA 94609-1809 - Phone
- (510) 428-3000
- NPI assigned
- Mar 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A79291 | CA | Primary |
Addresses
Primary practice location
747 52ND St
Oakland, CA 94609-1809
Mailing address
3498 Moraga Blvd
Lafayette, CA 94549-4421
Phone (925) 283-8465
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140414001840 | CA | Order and Referring Only - Pediatric Medicine | 8325136567 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79291 | CA | MD | Marriage & Family Therapist |
| A79291 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679602163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3498 MORAGA BLVD",
"city": "LAFAYETTE",
"state": "CA",
"postal_code": "945494421",
"telephone_number": "925-283-8465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "747 52ND ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946091809",
"telephone_number": "510-428-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUX",
"first_name": "JOAN",
"middle_name": "WIDMAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A79291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.