Individual provider Active NPI

Mary Margaret Roberts, RD, LD

  • Registered Dietitian
  • Tyler, TX
National Provider Identifier
1043196553
Registry record updated Sep 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DT92370 Issued in TX
Practice address
1120 E Front St
Tyler, TX 75702-8414
Phone
(903) 606-3630
Fax
(903) 606-3660
NPI assigned
Aug 12, 2025
Last updated
Sep 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DT92370 TX Primary

Addresses

Primary practice location

1120 E Front St
Tyler, TX 75702-8414

Mailing address

1120 E Front St
Tyler, TX 75702-8414
Phone (903) 606-3630

Other practice location 1

8934 S Broadway Ave Ste 448
Tyler, TX 75703-5475
Phone (903) 606-5100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250927000382 TX Practitioner - Registered Dietitian Or Nutrition Professional 1951806082 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1120 E Front St
Tyler, TX 75702-8414

2900 Saint Michael Dr
Suite 401
Texarkana, TX 75503-2343

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DT92370TXMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Nov 12, 2025 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Nov 12, 2025 Accepting new patients
Magella Medical Associates Billing, Inc. PastSince Aug 17, 2025 Accepting new patients

Locations

1120 E Front St
Tyler, TX 75702
Phone (903) 606-3630

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1754956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789603200000",
    "number": "1043196553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E FRONT ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028414",
            "telephone_number": "903-606-3630",
            "fax_number": "903-606-3660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 E FRONT ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028414",
            "telephone_number": "903-606-3630",
            "fax_number": "903-606-3660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8934 S Broadway Ave Ste 448",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757035475",
            "country_code": "US",
            "telephone_number": "903-606-5100",
            "fax_number": "903-606-5105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MARY",
        "middle_name": "MARGARET",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-12",
        "last_updated": "2026-09-17",
        "certification_date": "2026-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT92370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.