Ricky D Roach


Address: 15476 Dedeaux Rd, Gulfport, MS 39503-2637

Ricky D Roach (NPI# 1376561779, PAC ID# 5496774044) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PODIATRY.

Physician Overview

Nation Provider ID (NPI) 1376561779
PAC ID by PECOS 5496774044
Professional Enrollment ID I20051114000536
Full Name Ricky D Roach
Address 15476 Dedeaux Rd
Gulfport
MS 39503-2637
Gender M
Credential DPM
Medical School COLLEGE PODIATRIC MEDICINE AND SURGERY UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES
Graduation Year 1993
Primary Specialty PODIATRY
Accepts Medicare Assignment Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
250040 SINGING RIVER HOSPITAL
250007 MERIT HEALTH BILOXI
250019 MEMORIAL HOSPITAL AT GULFPORT

Other Locations

Address Phone Organization
1720 A Medical Park Dr, Suite 100, Biloxi, MS 39532-2122
15476 Dedeaux Rd, Gulfport, MS 39503-2637
999 N Halstead Rd, Ocean Springs, MS 39564-3105

Individual EP (Eligible Professionals) Public Reporting – Performance Scores
Physician Quality Reporting System (PQRS) and non-PQRS Qualified Clinical Data Registry (QCDR)

Measure Identifier Measure Title Performance Rate Reporting Mechanism
ACI_EC_TRANS_PPHI_1 Security Risk Analysis %
MIPS_EC_047_overall Care Plan 0%

Organization Information

Office Location

Street Address 15476 DEDEAUX RD
City GULFPORT
State MS
Zip 39503-2637

Physicians in the same location

Name Specialty Organization Address
Jonathan Dwaine Brown Orthopedic Surgery Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Henry T Leis Orthopedic Surgery Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Ophelia Abrahams Occupational Therapy Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Jason Lowery Physician Assistant Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Eric Jason Graham Orthopedic Surgery Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Nicole Lynn Johnson Nurse Practitioner Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Joseph Tyler Cox Orthopedic Surgery Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Duc Vinh Nguyen Nurse Practitioner Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Benjamin P Watts Physician Assistant Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Stephen Lee Ryder Physician Assistant Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Find all physicians in the same address

Physicians in the same zip code

Name Specialty Organization Address
Clarence Ray Quave Jr. Physical Therapy Encore Rehabilitation Inc 15476 B Dedeaux Rd, Gulfport, MS 39503-2637
Cherryl D Purvis Nurse Practitioner Heart Hypertension Cholesterol and Diabetes Care LLC 15444 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Joseph M Frame Physical Therapy 15444 Dedeaux Rd A, Gulfport, MS 39503-2637
Alvin Joseph Walsh Iii Nurse Practitioner Heart Hypertension Cholesterol and Diabetes Care LLC 15444 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Tiffany Lewallen Physical Therapy Encore Rehabilitation Inc 15476 B Dedeaux Rd, Gulfport, MS 39503-2637
Deborah Thompson-spencer Nurse Practitioner Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
George T Salloum Orthopedic Surgery Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Joel Tucker Orthopedic Surgery Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Alexander D Blevens Orthopedic Surgery Bienville Orthopaedic Specialists, LLC 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637
Forrest M Smith Physical Therapy Encore Rehabilitation Inc 15476 B Dedeaux Rd, Gulfport, MS 39503-2637
Find all physicians in zip 39503

Competitor

Search similar physicians

City GULFPORT
Zip Code 39503
Specialty PODIATRY
City + Specialty GULFPORT + PODIATRY

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS)
Jurisdiction Medicare

This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.

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