Individual provider Active NPI

Joshua Roose, DO

  • Sports Medicine (Family Medicine) Physician
  • Henderson, NV
National Provider Identifier
1962018671
Registry record updated Jun 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
CL0963 Issued in NV
Practice address
100 N Green Valley Pkwy Ste 325
Henderson, NV 89074-6393
Phone
(702) 986-0921
NPI assigned
Sep 17, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X OS21760 FL
Sports Medicine (Family Medicine) Physician 207QS0010X 20A24512 CA
Sports Medicine (Family Medicine) Physician 207QS0010X CL0963 NV Primary

Addresses

Primary practice location

100 N Green Valley Pkwy Ste 325
Henderson, NV 89074-6393

Mailing address

100 N Green Valley Pkwy Ste 325
Henderson, NV 89074-6393
Phone (702) 986-0921

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20251121003511 CA Practitioner - Family PracticePractitioner - Sports Medicine 8820490139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Michigan State University College of Osteopathic Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sierra Orthopedic Institute Medical CorporationGroup PAC ID 2163617804, 3 clinicians

Practice addresses (Care Compare)

13949 Mono Way
Sonora, CA 95370-2807
Phone (209) 533-5371

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24512CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sierra Orthopedic Institute Medical Corporation CurrentSince Sep 15, 2025 Accepting new patients

Locations

13949 Mono Way
Sonora, CA 95370
Phone (209) 213-9184

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782432000000",
    "number": "1962018671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N GREEN VALLEY PKWY STE 325",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890746393",
            "telephone_number": "702-986-0921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N GREEN VALLEY PKWY STE 325",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890746393",
            "telephone_number": "702-986-0921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOSE",
        "first_name": "JOSHUA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-17",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "FL",
            "license": "OS21760",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CA",
            "license": "20A24512",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NV",
            "license": "CL0963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.