Active NPI
Mary K Roberts, CRNA
- Certified Registered Nurse Anesthetist
- Princeton, WV
National Provider Identifier
1083772156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 19857
- Practice address
- 109 Morrison Dr
Princeton, WV 24740-2322 - Phone
- (304) 487-3559
- Fax
- (304) 487-7928
- NPI assigned
- Dec 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 19857 | WV | Primary |
Addresses
Primary practice location
109 Morrison Dr
Princeton, WV 24740-2322
Mailing address
PO Box 1143
Princeton, WV 24740-1143
Phone (304) 487-3559
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0066651000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19857 | WV | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East River Anesthesiology Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Princeton, WV
- NPI 1740711795
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420416000000",
"number": "1083772156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1143",
"city": "PRINCETON",
"state": "WV",
"postal_code": "247401143",
"telephone_number": "304-487-3559",
"fax_number": "304-487-7928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 MORRISON DR",
"city": "PRINCETON",
"state": "WV",
"postal_code": "247402322",
"telephone_number": "304-487-3559",
"fax_number": "304-487-7928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "MARY",
"middle_name": "K",
"name_prefix": "Mrs.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-04",
"last_updated": "2015-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "WV",
"license": "19857",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0066651000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Princeton, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.