Roshni Marballi Leboutillier, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS17920 Issued in FL

Practice address

8342 US Highway 301 N
Parrish, FL 34219-8653

Phone

(941) 729-4400

Fax

(941) 729-4424

NPI assigned

Apr 16, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Family Practice

Education

Nova Southeastern College of Osteo Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optumcare Florida, LLCGroup PAC ID 3072403476, 266 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: roshni.leboutillier@wellmed.eclinicaldirectplus.com

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.

• Optumcare Florida LLC

  • General Practice Physician
  • Tampa, FL
  • NPI 1053384214

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Optumcare Florida, LLC

  • Hospitalist Physician
  • Tampa, FL
  • NPI 1659884294
  NPD
• Optumcare Florida Ci, LLC

  • Primary Care Clinic/Center
  • Winter Park, FL
  • NPI 1720506603
  NPD (past)

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1780171793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5130 SUNFOREST DR STE 300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336346327",
            "telephone_number": "727-824-0780",
            "fax_number": "727-568-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8342 US HIGHWAY 301 N",
            "city": "PARRISH",
            "state": "FL",
            "postal_code": "342198653",
            "telephone_number": "941-729-4400",
            "fax_number": "941-729-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBOUTILLIER",
        "first_name": "ROSHNI",
        "middle_name": "MARBALLI",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-16",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS17920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Kutsyk, DDS
• Kathryn I. Lake, APRN
• Kristine Lamb
• Du Phu Le, PHARM D
• Phuong Anh Le, RPH
• Amanda Bryn Lee, ARNP
• Legacy Healthcare Inc
• Legacy Healthcare Inc
• Legacy Healthcare Inc
• Kelly Marie Lehman, LPC, M.ED, NCC

• Family Medicine Physician in Parrish, FL
• Providers in Parrish, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.
• 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.