Individual provider Active NPI

Brent Roberts, OD

  • Optometrist
  • Tahlequah, OK
National Provider Identifier
1114440138
Registry record updated Jul 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2949 Issued in OK
Practice address
1001 N Grand Ave
Tahlequah, OK 74464-7017
Phone
(918) 444-2109
NPI assigned
Jul 21, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2949 OK Primary

Addresses

Primary practice location

1001 N Grand Ave
Tahlequah, OK 74464-7017

Mailing address

118 Southland Dr
Tahlequah, OK 74464-5751
Phone (918) 869-8673

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170922001486 OK Practitioner - Optometry 1850665282 Reassigns benefits to 2 organizations
I20171023000619 TX Practitioner - Optometry 1850665282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Creek Nation Hospital and ClinicsGroup PAC ID 5698786226, 364 clinicians

Practice addresses (Care Compare)

10109 E 79TH St
Tulsa, OK 74133-4564
Phone (918) 756-4333

1313 E 20TH St
Okmulgee Indian Health Center
Okmulgee, OK 74447-6303
Phone (918) 591-5700

500 Eunice Burns Rd
Eufaula, OK 74432-4052
Phone (918) 689-2547

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.12 of 100Reported as group
Quality
83.76
Promoting interoperability
100
Improvement activities
40
Cost
56.64

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2949OKMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern State University College of Optometry Optometrist CurrentSince Jul 29, 2017 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jan 20, 2020 Accepting new patients
Creek Nation Hospital & Clinics Optometrist Current Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jan 20, 2020 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jan 1, 2021 Accepting new patients

Locations

1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201

1020 Lenape Dr
Nowata, OK 74048
Phone (918) 273-0192

1800 E Coplin St
Okemah, OK 74859
Phone (918) 623-1424

900 E Airport Rd
Okmulgee, OK 74447
Phone 91875643334448

900 N Owen Walters Blvd
Salina, OK 74365
Phone (918) 434-8500

1125 E Cleveland Ave
Sapulpa, OK 74066
Phone (918) 224-9310

1001 N Grand Ave
Tahlequah, OK 74464
Phone (918) 456-5511

870 E Crafton St
Tahlequah, OK 74464
Phone (918) 444-4000

100 S Bliss Ave
Tahlequah, OK 74464
Phone (918) 458-3100

Dept 1467
Tulsa, OK 74182

10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760

27371 S 4410 Rd
Vinita, OK 74301
Phone (918) 256-4800

Organizations & group practices 5

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": "1500595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500595200000",
    "number": "1114440138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 SOUTHLAND DR",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645751",
            "telephone_number": "918-869-8673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 N GRAND AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744647017",
            "telephone_number": "918-444-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-21",
        "last_updated": "2017-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.