Kylee J Roller, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

16771 15TH St NE
Buxton, ND 58218-9239

Phone

(701) 792-6488

Fax

(701) 335-7100

NPI assigned

Mar 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Lipp, Carlson, Witucki & Associates, LTD

  • Clinical Psychologist
  • Grand Forks, ND
  • NPI 1043316961

  ND

  Medicare reassignment NPD
• Roller Neurology

  • Neurology Physician
  • Grand Forks, ND
  • NPI 1780265009
  NPD

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610668800000",
    "number": "1750415873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16771 15TH ST NE",
            "city": "BUXTON",
            "state": "ND",
            "postal_code": "582189239",
            "telephone_number": "701-792-6488",
            "fax_number": "701-335-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16771 15TH ST NE",
            "city": "BUXTON",
            "state": "ND",
            "postal_code": "582189239",
            "telephone_number": "701-792-6488",
            "fax_number": "701-335-7100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2808 17th Ave S",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582014010",
            "country_code": "US",
            "telephone_number": "701-746-8376",
            "fax_number": "701-746-9872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROLLER",
        "first_name": "KYLEE",
        "middle_name": "J",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054519",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roller Psychology, PLLC

• All providers in Buxton, ND
• Psychologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; 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.

Verify at the official NPI Registry.