Individual provider Active NPI

Robert Richardson, NP

  • Nurse Practitioner
  • Roseburg, OR
National Provider Identifier
1134845407
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN-NP10000262 Issued in OR
Practice address
2460 NW Stewart Pkwy Ste 100
Roseburg, OR 97471-1516
Phone
(541) 229-2663
Fax
(541) 677-2294
NPI assigned
Oct 18, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN-NP10000262 OR Primary

Addresses

Primary practice location

2460 NW Stewart Pkwy Ste 100
Roseburg, OR 97471-1516

Mailing address

201 NW Medical Loop Ste 190
Roseburg, OR 97471-8835
Phone (541) 677-2452

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20221207002722 OR Practitioner - Nurse Practitioner 7719356179 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centennial Medical Group IncGroup PAC ID 6103982962, 60 clinicians

Practice addresses (Care Compare)

2460 NW Stewart Pkwy
Suite 100
Roseburg, OR 97471-1516
Phone (541) 229-2663

Hospital & facility affiliations

  • Mercy Medical Center Hospital, Roseburg, OR, CCN 380027

Merit-based Incentive Payment System (MIPS)

Final score
83.4 of 100Reported as group
Quality
67.01
Promoting interoperability
99
Improvement activities
40
Cost
78.48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN-NP10000262ORMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centennial Medical Group Inc. CurrentSince Jan 1, 2023 Accepting new patients
Centennial Medical Group Inc. CurrentSince Oct 23, 2022 Accepting new patients

Locations

2460 NW Stewart Pkwy
Ste 100
Roseburg, OR 97471
Phone (541) 229-2663

2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611

201 NW Medical Loop
Ste 190
Roseburg, OR 97471
Phone (541) 644-4319

Organizations & group practices 2

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.

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": "1666051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1134845407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 NW MEDICAL LOOP STE 190",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718835",
            "telephone_number": "541-677-2452",
            "fax_number": "541-677-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 NW STEWART PKWY STE 100",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974711516",
            "telephone_number": "541-229-2663",
            "fax_number": "541-677-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "ROBERT",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-18",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "APRN-NP10000262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.