Joanna Lyn Roberts, PA, PTA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

52879 Issued in CA

Practice address

411 Grand Ave
Oakland, CA 94610-5022

Phone

(510) 844-4097

NPI assigned

Feb 27, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Carbon Health Primary Care of California PC

  • Multi-Specialty Clinic/Center
  • Berkeley, CA
  • NPI 1972057990
  NPD (past)

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523923200000",
    "number": "1164559506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 GRAND AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946105022",
            "telephone_number": "510-844-4097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 GRAND AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946105022",
            "telephone_number": "510-844-4097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JOANNA",
        "middle_name": "LYN",
        "credential": "PA, PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2018-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "904080",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anita Roberts, RN
• Cassandra Angelique Roberts
• Cyrus Roberts
• David C Roberts, PH.D.
• Gayle D Roberts
• Rima A Roberts, M.A.
• Brittany Robertson, B.A
• Eric James Robertson
• Jeraldine Robertson, MFT
• Jocelyn Robertson

• Physician Assistant in Oakland, CA
• Providers in Oakland, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.