Individual provider Active NPI

Elizabeth Ann Roush

  • Occupational Therapist
  • Hagerstown, MD
National Provider Identifier
1770099277
Registry record updated May 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OC012636 Issued in PA
Practice address
20009 Rosebank Way
Hagerstown, MD 21742-6739
Phone
(301) 880-7598
NPI assigned
Dec 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 08349 MD
Occupational Therapist 225X00000X OC012636 PA Primary

Addresses

Primary practice location

20009 Rosebank Way
Hagerstown, MD 21742-6739

Mailing address

272 Dani Brooke Dr
Mont Alto, PA 17237-9680
Phone (252) 917-9789

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180212002360 MD Practitioner - Occupational Therapist in Private Practice 6709146756 Reassigns benefits to 1 organization
I20180212002635 DC Practitioner - Occupational Therapist in Private Practice 6709146756 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fox Rehab OT MD LLCGroup PAC ID 4981847977, 60 clinicians

Practice addresses (Care Compare)

11665 Doolittle Dr
Waldorf, MD 20602-2898
Phone (877) 407-3422

6451 N Charles St
Baltimore, MD 21212-1010
Phone (877) 407-3422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
08349MDMDOccupational Therapist
OC012636PAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Rehab OT MD LLC Occupational Therapist CurrentSince Jan 22, 2018 Accepting new patients

Locations

11665 Doolittle Dr
Waldorf, MD 20602
Phone (301) 638-4100

Organizations & group practices 2

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": "1513641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557792000000",
    "number": "1770099277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 DANI BROOKE DR",
            "city": "MONT ALTO",
            "state": "PA",
            "postal_code": "172379680",
            "telephone_number": "252-917-9789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20009 ROSEBANK WAY",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426739",
            "telephone_number": "301-880-7598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSH",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-19",
        "last_updated": "2019-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "08349",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "PA",
            "license": "OC012636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.