Individual provider Active NPI

Kacey Byrd Roberts, DPT

  • Physical Therapist
  • Amory, MS
National Provider Identifier
1114694023
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT7210 Issued in MS
Practice address
1112 Highway 278 E Ste a
Amory, MS 38821-5626
Phone
(662) 257-4048
Fax
(662) 257-7080
NPI assigned
Aug 27, 2021
Last updated
Aug 31, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT7210 MS Primary

Addresses

Primary practice location

1112 Highway 278 E Ste a
Amory, MS 38821-5626

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 206-4158

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210927000712 MS Practitioner - Physical Therapist in Private Practice 8022415504 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Drayer Physical Therapy Mississippi LLCGroup PAC ID 3274834858, 113 clinicians

Practice addresses (Care Compare)

1112 Maria LN
Iuka, MS 38852-1119
Phone (662) 593-3111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dpti Elite Physical Therapy LLC Physical Therapist CurrentSince Aug 30, 2021 Accepting new patients
Dpti Elite Physical Therapy LLC Physical Therapist CurrentSince Aug 30, 2021 Accepting new patients
Drayer Physical Therapy Mississippi LLC Physical Therapist CurrentSince Aug 30, 2021 Accepting new patients
Drayer Physical Therapy Mississippi LLC Physical Therapist Past Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

117 Bo Bo Dr
Crystal Springs, MS 39059
Phone (601) 892-6330

1110 S Adams St
Fulton, MS 38843
Phone (662) 862-4101

1112 Maria Ln
Iuka, MS 38852
Phone (662) 593-3111

2319 Highway 145
Saltillo, MS 38866
Phone (662) 869-9980

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1114694023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-206-4158",
            "fax_number": "717-773-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 HIGHWAY 278 E STE A",
            "city": "AMORY",
            "state": "MS",
            "postal_code": "388215626",
            "telephone_number": "662-257-4048",
            "fax_number": "662-257-7080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KACEY",
        "middle_name": "BYRD",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT7210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Amory, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.