Active NPI
Roshan Bista, MD
- Hospitalist Physician
- Memphis, TN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- 036145571
- 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, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 214881 | Other | IL | GROUP PTAN |
Electronic endpoints 3
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036145571 | IL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 24 On Physicians, PC | Multi-Specialty | Current | Accepting new patients |
| Southern Illinois Medical Services, NFP | Multi-Specialty | Current | Accepting new patients |
| 24 On Physicians, P.C. | Multi-Specialty | Current | 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
- rbista25605@sih.direct-ci.com
- 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.
-
dba SIH Medical Group
- Internal Medicine Physician
- Carbondale, IL
- NPI 1770656837
Multi-Specialty
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; 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.