Individual provider Active NPI

Marquis Roberts, RN

  • Family Nurse Practitioner
  • Visalia, CA
National Provider Identifier
1104591825
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95019607 Issued in CA
Practice address
400 E Oak Ave
Visalia, CA 93291-5034
Phone
(877) 960-3426
NPI assigned
Aug 13, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Registered Nurse 163WE0003X 832164 CA
Family Nurse Practitioner 363LF0000X 95019607 CA Primary

Addresses

Primary practice location

400 E Oak Ave
Visalia, CA 93291-5034

Mailing address

385 S 8TH St
Grover Beach, CA 93433-2344
Phone (757) 879-7945

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20220304000308 CA Practitioner - Nurse Practitioner 7810381092 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
832164CAMDEmergency Registered Nurse
95019607CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network CurrentSince Jan 17, 2022 Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network CurrentSince Jan 17, 2022 Accepting new patients
Family Healthcare Network Current Accepting new patients

Locations

31180 Road 72
Visalia, CA 93291
Phone (559) 651-2301

305 E Center Ave
Visalia, CA 93291
Phone (559) 737-4792

400 E Oak Ave
Visalia, CA 93291
Phone (559) 741-4500

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CCECCA
  • Direct secure messaging: marquis.roberts.1@17661.direct.athenahealth.com

Organizations & group practices 7

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": "1628812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1104591825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 S 8TH ST",
            "city": "GROVER BEACH",
            "state": "CA",
            "postal_code": "934332344",
            "telephone_number": "757-879-7945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E OAK AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932915034",
            "telephone_number": "877-960-3426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MARQUIS",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-13",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "CA",
            "license": "832164",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95019607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Visalia, CA

Sources for this page

Verify at the official NPI Registry.