Active NPI
Branden M Roberts
- Physical Medicine & Rehabilitation Physician
- Lake City, IA
National Provider Identifier
1154979557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 082695
- Practice address
- 1301 W Main St
Lake City, IA 51449-1585 - Phone
- (712) 464-3171
- Fax
- (712) 464-3269
- NPI assigned
- Aug 28, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 082695 | IA | Primary |
Addresses
Primary practice location
1301 W Main St
Lake City, IA 51449-1585
Mailing address
1301 W Main St
Lake City, IA 51449-1585
Phone (712) 464-3171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 082695 | IA | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566950400000",
"number": "1154979557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 W MAIN ST",
"city": "LAKE CITY",
"state": "IA",
"postal_code": "514491585",
"telephone_number": "712-464-3171",
"fax_number": "712-464-3269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 W MAIN ST",
"city": "LAKE CITY",
"state": "IA",
"postal_code": "514491585",
"telephone_number": "712-464-3171",
"fax_number": "712-464-3269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "BRANDEN",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-28",
"last_updated": "2019-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "IA",
"license": "082695",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.