NPIMap

Organization Active NPI

Roger C Roque MD PA

Doing business as St. Francis Primary Care Clinic

  • Family Medicine Physician
  • Eustis, FL
National Provider Identifier
1932215043
Registry record updated Aug 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME0070970 Issued in FL
Legal business name
ROGER C ROQUE MD PA
Doing business as
St. Francis Primary Care Clinic
Practice address
720 N Bay St
Suite 8
Eustis, FL 32726-2964
Phone
(352) 357-1014
Fax
(352) 357-3130
NPI assigned
Aug 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2011

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

Authorized official

Name
Roger Cagandahan Roque, M.D.
Title
Family Physician
Phone
(352) 357-1014

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X ME0070970 FL Primary

Addresses

Primary practice location

720 N Bay St
Suite 8
Eustis, FL 32726-2964

Mailing address

PO Box 1386
Eustis, FL 32727-1386
Phone (352) 357-1014

Other identifiers 2

IdentifierTypeStateIssuer
31407OtherBLUE CROSS BLUE SHIELD
279151000MedicaidFL

Other names 1

  • St. Francis Primary Care Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

720 N Bay St
Ste 8
Eustis, FL 32726
Phone (352) 357-1014

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314057600000",
    "number": "1932215043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1386",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327271386",
            "telephone_number": "352-357-1014",
            "fax_number": "352-357-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N BAY ST",
            "address_2": "SUITE 8",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327262964",
            "telephone_number": "352-357-1014",
            "fax_number": "352-357-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER C ROQUE MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2011-08-23",
        "status": "A",
        "authorized_official_last_name": "ROQUE",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "CAGANDAHAN",
        "authorized_official_title_or_position": "FAMILY PHYSICIAN",
        "authorized_official_telephone_number": "352-357-1014",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0070970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "31407",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "279151000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Francis Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eustis, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.