Theodore Steven Roosevelt, M.D.

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

M6142 Issued in ID

Practice address

13909 W Wainwright Dr
Boise, ID 83713-1969

Phone

(208) 389-2213

Fax

(208) 389-4659

NPI assigned

Jan 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

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

Specialty

EndocrinologyAlso: Internal Medicine

Education

University of Utah School of Medicine, 1974

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Idaho Diabetes and Endocrine Associates, PA

  • Endocrinology, Diabetes & Metabolism Physician
  • Boise, ID
  • NPI 1790960961
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1699754697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13909 W WAINWRIGHT DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131969",
            "telephone_number": "208-389-2213",
            "fax_number": "208-389-4659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13909 W WAINWRIGHT DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131969",
            "telephone_number": "208-389-2213",
            "fax_number": "208-389-4659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOSEVELT",
        "first_name": "THEODORE",
        "middle_name": "STEVEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-10",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M6142",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "ID",
            "license": "M6142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002712100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Ronquillo, DNP
• Ashley Ann Rood, NP
• Room to Breathe Counseling
• Melissa Arvilla Roop, MD
• Roger G Roos, MD
• Laura E Root, LCSW
• Rachel Anne Root, PHD
• Timothy John Root, D.C.
• Rooted Recovery and Wellness, LLC
• Rooted Resilience Wellness PLLC

• Endocrinology, Diabetes & Metabolism Physician in Boise, ID
• Providers in Boise, ID by specialty
• Endocrinology, Diabetes & Metabolism Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.