Active NPI
Valisa Jean Roysdon, AUD
- Audiologist
- Indianapolis, IN
National Provider Identifier
1962419168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 23001175A
- Practice address
- 1701 Senate Blvd
Suite Ag045
Indianapolis, IN 46202-1239 - Phone
- (317) 962-4836
- Fax
- (317) 962-4812
- NPI assigned
- Aug 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 23001175 | IN | |
| Audiologist | 231H00000X | 23001175A | IN | Primary |
Addresses
Primary practice location
1701 Senate Blvd
Suite Ag045
Indianapolis, IN 46202-1239
Mailing address
250 N Shadeland Ave
Indianapolis, IN 46219-4959
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200544370 | Medicaid | IN | |
| 000001070985 | Other | IN | ANTHEM PROVIDER NUMBER |
| 300000626 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23001175 | IN | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Medical Diagnostic Associates, Inc. | Past | Accepting new patients |
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.
-
- Internal Medicine Physician
- Indianapolis, IN
- NPI 1861441537
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607558400000",
"number": "1962419168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N SHADELAND AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 SENATE BLVD",
"address_2": "SUITE AG045",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462021239",
"telephone_number": "317-962-4836",
"fax_number": "317-962-4812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROYSDON",
"first_name": "VALISA",
"middle_name": "JEAN",
"credential": "AUD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2020-12-10",
"certification_date": "2020-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "IN",
"license": "23001175",
"primary": false
},
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "IN",
"license": "23001175A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200544370",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "000001070985",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300000626",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.