Samuel J Roberts, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

23376 Issued in TX

Practice address

601 S Main St
Ste 216
Grapevine, TX 76051-5385

Phone

(817) 424-5157

Fax

(817) 424-1766

NPI assigned

Mar 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Samuel J. Roberts and Associates

  • Clinical Psychologist
  • Grapevine, TX
  • NPI 1154678241
  NPD (past) Authorized official

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531526400000",
    "number": "1114041340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 38326",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752380326",
            "telephone_number": "214-341-3822",
            "fax_number": "817-424-1766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S MAIN ST",
            "address_2": "STE 216",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760515385",
            "telephone_number": "817-424-5157",
            "fax_number": "817-424-1766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "SAMUEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2018-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "23376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• RLS Supermarkets LLC (Minyard Pharmacy #76)
• James Loren Roberds, PHARMD.
• Rebecca Maring Robert, MD
• William Pierre Robert III, MD
• Madison Roberts, MS, LPC ASSOCIATE
• Melissa Robilliard, LPC
• Joshua Robinett
• Carolyn Robinson, RBT
• Clayton Robinson, MA, LPC
• Demetrices Robinson

• Psychologist in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.