E. Dwain Roberts, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

114884 Issued in MO

Practice address

1241 W Stadium Blvd
Jefferson City, MO 65109-6023

Phone

(573) 556-7755

Fax

(573) 761-3599

NPI assigned

Jan 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Diagnostic Radiology

Education

University of Texas Southwestern Medical School at Dallas, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jefferson City Medical Group PCGroup PAC ID 1850371089, 117 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dwain.roberts@jcmg.eclinicaldirectplus.com

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.

• Jefferson City Medical Group, P.C.

  • Multi-Specialty Clinic/Center
  • Jefferson City, MO
  • NPI 1336189398
  Medicare reassignment Care Compare group NPD
• JCMG Ancillary Services, LLC

  • Radiology Clinic/Center
  • Jefferson City, MO
  • NPI 1841261153
  NPD
• Jefferson City Medical Group, P.C.

  • Hematology & Oncology Physician
  • Jefferson City, MO
  • NPI 1215093257
  NPD
• Jefferson City Medical Group, P.C.

  • Clinical Medical Laboratory
  • Jefferson City, MO
  • NPI 1811292105
  NPD
• University Radiology Associates

  • Diagnostic Radiology Physician
  • Salt Lake City, UT
  • NPI 1639124498

  Nuclear Radiology

  NPD (past)

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1013997782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104240",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651104240",
            "telephone_number": "573-556-7755",
            "fax_number": "573-761-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 W STADIUM BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096023",
            "telephone_number": "573-556-7755",
            "fax_number": "573-761-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "E.",
        "middle_name": "DWAIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "MO",
            "license": "114884",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "MO",
            "license": "114884",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "114884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209786607",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP",
            "identifier": "CC7852",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300090314",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP RR",
            "identifier": "DB1586",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IND. RR",
            "identifier": "P00201659",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "Bluemark",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd Ste 120",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Riyan Dental LLC
• Nicole Brook Roach, PTA, LMT
• Alane Elizabeth Roath, LPC
• Thomas D. Robbins, M.D.
• Roberts Drug Store, LLC
• Emily Louise Roberts, CPNP
• Jonathan M. Roberts, M.D.
• Kimberly Ann Roberts
• Sarah Lillian Roberts, MD
• Joel Robinette, DO

• Diagnostic Radiology Physician in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Diagnostic Radiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.