Individual provider Active NPI

Roshan Bista, MD

  • Hospitalist Physician
  • Memphis, TN
National Provider Identifier
1730564428
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
036145571 Issued in IL
Practice address
University of Tennessee 920 Madison Avenue Suite 447
Memphis, TN 38163-1462
Phone
(615) 222-1434
NPI assigned
Jul 23, 2015
Last updated
Jun 29, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 036145571 IL
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X 036145571 IL Primary

Addresses

Primary practice location

University of Tennessee 920 Madison Avenue Suite 447
Memphis, TN 38163-1462

Mailing address

4220 Harding Pike
Nashville, TN 37205-2005
Phone (615) 222-1434

Other practice location 1

405 W Jackson St
Carbondale, IL 62901-1462
Phone (618) 549-0721 ext. 65126

Other practice location 2

2 S Hospital Dr
Murphysboro, IL 62966-3333
Phone (618) 684-3156 ext. 55321

Other practice location 3

201 S 14th St
Herrin, IL 62948-3631
Phone (618) 942-2171 ext. 35760

Other identifiers 1

IdentifierTypeStateIssuer
214881OtherILGROUP PTAN

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address rbista25605@sih.direct-ci.com
Direct Messaging Address rbista25605@sih.direct-ci.com
Direct Messaging Address rbista25605@sih.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20180725001320 IL Practitioner - HospitalistPractitioner - Family Practice 8820345606 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036145571ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
24 On Physicians, PC Multi-Specialty CurrentSince Feb 1, 2023 Accepting new patients
Southern Illinois Medical Services, NFP Multi-Specialty CurrentSince Jul 16, 2018 Accepting new patients
24 On Physicians, P.C. Multi-Specialty CurrentSince Feb 1, 2023 Accepting new patients

Locations

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

405 W Jackson St
Carbondale, IL 62901

201 S 14th St
Herrin, IL 62948
Phone (618) 942-2171

2 S Hospital Dr
Murphysboro, IL 62966
Phone (618) 684-3156

1100 E Norris Dr
Ottawa, IL 61350
Phone (815) 416-1224

Interoperability endpoints

  • Direct secure messaging: rbista25605@sih.direct-ci.com
  • Direct secure messaging: roshan.bista.1@7654.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1730564428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 HARDING PIKE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372052005",
            "telephone_number": "615-222-1434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF TENNESSEE 920 MADISON AVENUE SUITE 447",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381631462",
            "telephone_number": "615-222-1434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "405 W Jackson St",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011462",
            "country_code": "US",
            "telephone_number": "618-549-0721 x65126",
            "fax_number": "618-529-0479",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 S Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Murphysboro",
            "state": "IL",
            "postal_code": "629663333",
            "country_code": "US",
            "telephone_number": "618-684-3156 x55321",
            "fax_number": "618-684-1040",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 S 14th St",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483631",
            "country_code": "US",
            "telephone_number": "618-942-2171 x35760",
            "fax_number": "618-988-6166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BISTA",
        "first_name": "ROSHAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-23",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036145571",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036145571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "214881",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rbista25605@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "201 S 14th St",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629483631",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rbista25605@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2 S Hospital Dr",
            "city": "Murphysboro",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629663333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rbista25605@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "405 W Jackson St",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.