Individual provider Active NPI

John D Roaten, M.D.

  • Pediatric Orthopaedic Surgery Physician
  • Fort Worth, TX
National Provider Identifier
1760619878
Registry record updated Aug 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Orthopaedic Surgery PhysicianTaxonomy code 207XP3100X
License
P3807 Issued in TX
Practice address
1500 Cooper St
Fort Worth, TX 76104-2710
Phone
(682) 885-4405
Fax
(682) 885-4407
NPI assigned
Jun 16, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Orthopaedic Surgery Physician 207XP3100X P3807 TX Primary

Addresses

Primary practice location

1500 Cooper St
Fort Worth, TX 76104-2710

Mailing address

PO Box 733784
Dallas, TX 75373-3784
Phone (682) 885-1855

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20150709001898 TX Practitioner - Orthopedic SurgeryPractitioner - Pediatric Medicine 8325266794 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dallas Physician Medical Services for Children Inc CurrentSince Aug 1, 2022 Accepting new patients
Dallas Physician Medical Services for Children Inc CurrentSince Aug 1, 2022 Accepting new patients
CC Bpci PLC Past Accepting new patients
Legacy Trail Surgery Center, LLC Past Accepting new patients

Locations

1935 Medical District Dr
Dallas, TX 75235
Phone (214) 456-2735

7211 Preston Rd
Ste 2100
Plano, TX 75024
Phone (469) 303-0104

7601 Preston Rd
Plano, TX 75024
Phone (469) 303-7300

7211 Preston Rd
Ste 1200
Plano, TX 75024
Phone (469) 303-3000

Interoperability endpoints

  • Direct secure messaging: jroaten514807@direct.childrens.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1760619878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 COOPER ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042710",
            "telephone_number": "682-885-4405",
            "fax_number": "682-885-4407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROATEN",
        "first_name": "JOHN",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-16",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "TX",
            "license": "P3807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.