Individual provider Active NPI

Romeo Rosales, PAC

  • Physician Assistant
  • Las Vegas, NV
National Provider Identifier
1952372898
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA862 Issued in NV
Practice address
1276 S Nellis Blvd
Las Vegas, NV 89104-5782
Phone
(725) 269-6465
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA862 NV Primary

Addresses

Primary practice location

1276 S Nellis Blvd
Las Vegas, NV 89104-5782

Mailing address

102 Woodmont Blvd Ste 600
Nashville, TN 37205-5250
Phone (888) 987-1151

Other practice location 1

2300 W Charleston Blvd
Pain Mgmt
Las Vegas, NV 89102-2149
Phone (702) 877-5370

Other practice location 2

4500 W Oakey Blvd
Las Vegas, NV 89102-1527
Phone (702) 873-5100

Other identifiers 3

IdentifierTypeStateIssuer
100504055MedicaidNV
PA862OtherNVSTATE LICENSE
1952372898MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040916000978 NV Practitioner - Physician Assistant 6103893276 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Archwell Health Professional Services of Nevada PCGroup PAC ID 3779966999, 14 clinicians

Practice addresses (Care Compare)

1501 W Sunset Rd
Henderson, NV 89014-6636
Phone (725) 269-7001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10705MNMDFamily Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: romeo.rosales.1@18353.direct.athenahealth.com

Organizations & group practices 1

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1952372898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD STE 600",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372055250",
            "telephone_number": "888-987-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1276 S NELLIS BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891045782",
            "telephone_number": "725-269-6465"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2300 W Charleston Blvd",
            "address_2": "Pain Mgmt",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891022149",
            "country_code": "US",
            "telephone_number": "702-877-5370",
            "fax_number": "702-366-9064",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4500 W Oakey Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891021527",
            "country_code": "US",
            "telephone_number": "702-873-5100",
            "fax_number": "702-873-8093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSALES",
        "first_name": "ROMEO",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100504055",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA862",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952372898",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.