Individual provider Active NPI

William Roberts, MSN, AGPCNP-BC

  • Primary Care Nurse Practitioner
  • Cleveland, OH
National Provider Identifier
1043602675
Registry record updated Feb 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
COA.16636-NP Issued in OH
Practice address
18101 Lorain Ave
Cleveland, OH 44111-5612
Phone
(216) 476-7000
NPI assigned
Feb 18, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X COA.16636-NP OH Primary

Addresses

Primary practice location

18101 Lorain Ave
Cleveland, OH 44111-5612

Mailing address

18101 Lorain Ave
Cleveland, OH 44111-5612
Phone (216) 476-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150417001028 OH Practitioner - Nurse Practitioner 7618295833 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
COA.16636-NPOHMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Hospital CurrentSince Mar 10, 2015 Accepting new patients
Fairview Hospital CurrentSince Mar 10, 2015 Accepting new patients

Locations

18101 Lorain Ave
Cleveland, OH 44111
Phone (216) 476-7029

10654 Lorain Ave
Cleveland, OH 44111
Phone (216) 941-1044

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1424217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424217600000",
    "number": "1043602675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18101 LORAIN AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441115612",
            "telephone_number": "216-476-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18101 LORAIN AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441115612",
            "telephone_number": "216-476-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "WILLIAM",
        "credential": "MSN, AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-18",
        "last_updated": "2015-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "COA.16636-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.