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Deactivated NPI 1215014998 Deactivated / Inactive NPI Male Practitioner

Dr. Roger William Roubal , DDS

Dentist - General Practice • Omaha, NE

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Roger Roubal has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 01, 2006
NPI Deactivation Date March 16, 2026
Total Practice Duration ~20 Years of Practice (2006 – 2026)

Professional Overview & Biography Verified Profile Summary

Dr. Roger Roubal, DDS was a registered Dentist - General Practice practicing in Omaha, NE. Throughout an active medical career spanning 20 years, Dr. Roubal provided care at the practice location at 11919 GRANT ST until profile deactivation on 2026-03-16.

Historical Medicare Part B clinical services included x-ray of lower jaws, upper jaws and teeth, new patient outpatient office visit, established patient outpatient office visit. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

11919 Grant St
Suite 140

Omaha, NE 681643475

Telephone 4024934175
Fax 4024939273
Associated Practice Facility / Clinic
🏢 Popp Cosmetic Surgery Pc Facility NPI 1013984665

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Omaha, NE

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 13.8 Yrs
State Avg: 19.2 Yrs
Regional Practice Density
282 Specialists

Practicing in Omaha, NE (832 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
76.0% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2021)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
70355 X-ray of lower jaws, upper jaws and teeth
61 61 $100.00 $16.42
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more
58 58 $550.00 $149.38
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more
23 23 $250.00 $50.08

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License NE 4339

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Phillip Brigden , DDS

Dentist - General Practice

NPI 1013297332

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated March 16, 2026

Record deactivated on March 16, 2026

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 11919 GRANT ST, SUITE 140, OMAHA, NE 681643475 (Tel: 4024934175)

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Updated Business Mailing Address July 08, 2007

Registered at 11919 GRANT ST, SUITE 140, OMAHA, NE 681643475 (Tel: 4024934175)

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Provider Name / Credentials Updated July 08, 2007

Recorded as ROGER ROUBAL, D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #4339 in NE)

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Initial NPI Registration & Enumeration November 01, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1215014998
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 01, 2006
Last Update: July 08, 2007
Deactivation Date: March 16, 2026

Mailing Address

11919 Grant St, Suite 140

Omaha, NE 681643475

Phone: 4024934175

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.