Active NPI
Mary Elizabeth Roehmholdt, M.D.
- Neurology Physician
- Williamsville, NY
National Provider Identifier
1972772838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 128036-1
- Practice address
- 300 Essjay Rd
Ste 105
Williamsville, NY 14221-8208 - Phone
- (716) 634-6357
- Fax
- (716) 634-3448
- NPI assigned
- Feb 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 128036-1 | NY | Primary |
Addresses
Primary practice location
300 Essjay Rd
Ste 105
Williamsville, NY 14221-8208
Mailing address
300 Essjay Rd
Ste 105
Williamsville, NY 14221-8208
Phone (716) 634-6357
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CPN-N-128036-1 | Other | NY | NYS COMPENSATION |
| 00481021 | Medicaid | NY | |
| 130003589 | Other | NY | MEDICARE RAILROAD |
| 00020058901 | Other | NY | UNIVERA |
| 005077825 | Other | NY | BLUE CROSS /BLUE SHIELD |
| 389594 | Other | NY | WELLCARE |
| 05-02672 | Other | NY | IHA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 128036-1 | NY | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388016000000",
"number": "1972772838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 ESSJAY RD",
"address_2": "STE 105",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142218208",
"telephone_number": "716-634-6357",
"fax_number": "716-634-3448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 ESSJAY RD",
"address_2": "STE 105",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142218208",
"telephone_number": "716-634-6357",
"fax_number": "716-634-3448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROEHMHOLDT",
"first_name": "MARY",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-25",
"last_updated": "2013-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NY",
"license": "128036-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NYS COMPENSATION",
"identifier": "CPN-N-128036-1",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00481021",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "130003589",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNIVERA",
"identifier": "00020058901",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS /BLUE SHIELD",
"identifier": "005077825",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "389594",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHA",
"identifier": "05-02672",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Williamsville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.