Individual provider Active NPI

Ryan J Roberts, D.O.

  • Emergency Medicine Physician
  • Grand Blanc, MI
National Provider Identifier
1093982910
Registry record updated Sep 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101017160 Issued in MI
Practice address
1 Genesys Pkwy
Grand Blanc, MI 48439-8065
Phone
(810) 606-5000
NPI assigned
May 9, 2008
Last updated
Sep 29, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101017160 MI Primary

Addresses

Primary practice location

1 Genesys Pkwy
Grand Blanc, MI 48439-8065

Mailing address

1 Genesys Pkwy
Grand Blanc, MI 48439-8065
Phone (810) 606-5000

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20111021000227 ID Practitioner - Emergency Medicine 2466624259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

746 N College Rd
Twin Falls, ID 83301-3486

801 Pole Line Rd W
Twin Falls, ID 83301-5810

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.09 of 100Reported as group
Quality
77.1
Promoting interoperability
100
Improvement activities
40
Cost
73.19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101017160MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Clinic LLC CurrentSince Oct 1, 2016 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230

775 Pole Line Rd W
Twin Falls, ID 83301
Phone (208) 814-1000

801 Pole Line Rd W
Twin Falls, ID 83301
Phone (208) 814-1000

Interoperability endpoints

  • Direct secure messaging: rroberts32588@direct.slhs.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222646400000",
    "number": "1093982910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398065",
            "telephone_number": "810-606-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398065",
            "telephone_number": "810-606-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "RYAN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-09",
        "last_updated": "2008-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101017160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

Verify at the official NPI Registry.