NPIMap

Individual provider Active NPI

Mario Rizalino Bascon Roa Jr., M.D.

  • Family Medicine Physician
  • College Station, TX
National Provider Identifier
1740445758
Registry record updated Nov 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
N7865 Issued in TX
Practice address
4421 Highway 6 S Ste 100
College Station, TX 77845-6176
Phone
(979) 731-5200
Fax
(979) 731-5210
NPI assigned
Jul 20, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 28, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X N7865 TX Primary

Addresses

Primary practice location

4421 Highway 6 S Ste 100
College Station, TX 77845-6176

Mailing address

1530 Texas Ave S Ste 100
College Station, TX 77840-3329
Phone (979) 690-4878

Other practice location 1

1530 Texas Ave S Ste 100
College Station, TX 77840-3329
Phone (979) 690-4878

Other identifiers 1

IdentifierTypeStateIssuer
280666302MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20110328000445 TX Practitioner - Family Practice 5092998187 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph Regional Health CenterGroup PAC ID 5294727921, 141 clinicians

Practice addresses (Care Compare)

2010 E Villa Maria Rd
Suite a
Bryan, TX 77802-2583
Phone (979) 731-5200

2801 Franciscan Dr
Bryan, TX 77802-2544
Phone (979) 776-2401

4401 State Hwy 6 S
College Station, TX 77845-4428
Phone (979) 690-4480

Hospital & facility affiliations

  • CHI St Joseph Health Regional Hospital Hospital, Bryan, TX, CCN 450011

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph Regional Health Center CurrentSince May 14, 2015 Accepting new patients
St. Joseph Regional Health Center Family Medicine CurrentSince May 14, 2015 Accepting new patients
College Station Hospital LP Past Accepting new patients
St Joseph Physician Associates Family Medicine Past Accepting new patients
Jonathan a. Friedman, M.D., PLLC Past Accepting new patients
Mario R Roa Jr MD PA Family Medicine PastSince Oct 20, 2010 Accepting new patients

Locations

2801 Franciscan Dr
Bryan, TX 77802
Phone (409) 776-3777

2800 S Texas Ave
Ste 202
Bryan, TX 77802
Phone (979) 774-2060

1530 Texas Ave S
Ste 100
College Station, TX 77840
Phone (979) 690-4878

4421 State Highway 6 S
Ste 100
College Station, TX 77845
Phone (979) 731-5200

Interoperability endpoints

  • Direct secure messaging: mroa458186@direct.stlukeshealth.org
  • Direct secure messaging: mario.roa@sjrhc.eclinicaldirectplus.com

Organizations & group practices 10

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.

Hospital & facility affiliations 2

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": "1216512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543363200000",
    "number": "1740445758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 TEXAS AVE S STE 100",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778403329",
            "telephone_number": "979-690-4878",
            "fax_number": "979-690-4879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4421 HIGHWAY 6 S STE 100",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778456176",
            "telephone_number": "979-731-5200",
            "fax_number": "979-731-5210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1530 Texas Ave S Ste 100",
            "address_purpose": "LOCATION",
            "city": "College Station",
            "state": "TX",
            "postal_code": "778403329",
            "country_code": "US",
            "telephone_number": "979-690-4878",
            "fax_number": "979-690-4879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROA",
        "first_name": "MARIO RIZALINO",
        "middle_name": "BASCON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-20",
        "last_updated": "2018-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N7865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "280666302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in College Station, TX

Sources for this page

Verify at the official NPI Registry.