Individual provider Active NPI

James R Roberts, P.T.

  • Physical Therapist
  • Merrick, NY
National Provider Identifier
1174694541
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
020672-1 Issued in NY
Practice address
2092 Merrick Ave
Merrick, NY 11566-3147
Phone
(516) 223-4300
Fax
(516) 223-1142
NPI assigned
Nov 10, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 020672-1 NY Primary

Addresses

Primary practice location

2092 Merrick Ave
Merrick, NY 11566-3147

Mailing address

1 Gorham LN
Dix Hills, NY 11746-6156

Other identifiers 1

IdentifierTypeStateIssuer
826161OtherNYMANAGED PHYSICAL NETWORK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070223000247 NY Practitioner - Physical Therapist in Private Practice 1052413945 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Merrick Physical Therapy PLLCGroup PAC ID 6305998634, 4 clinicians

Practice addresses (Care Compare)

2092 Merrick Ave
Merrick, NY 11566-3147
Phone (516) 223-4300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
020672-1NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Merrick Physical Therapy PLLC Physical Therapist CurrentSince Aug 1, 2009 Accepting new patients

Locations

759 Pulaski Rd
Greenlawn, NY 11740
Phone (631) 261-6680

2092 Merrick Ave
North Merrick, NY 11566
Phone (516) 223-4300

Organizations & group practices 1

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": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174694541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GORHAM LN",
            "city": "DIX HILLS",
            "state": "NY",
            "postal_code": "117466156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2092 MERRICK AVE",
            "city": "MERRICK",
            "state": "NY",
            "postal_code": "115663147",
            "telephone_number": "516-223-4300",
            "fax_number": "516-223-1142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JAMES",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "020672-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MANAGED PHYSICAL NETWORK",
            "identifier": "826161",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrick, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.