Individual provider Active NPI

John Roberts, M.D.

  • Family Medicine Physician
  • Seattle, WA
National Provider Identifier
1184912628
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD 60430842 Issued in WA
Practice address
125 16TH Ave E
Seattle, WA 98112-5211
Phone
(206) 326-3530
NPI assigned
Jul 19, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD 60430842 WA Primary

Addresses

Primary practice location

125 16TH Ave E
Seattle, WA 98112-5211

Mailing address

125 16TH Ave E
Seattle, WA 98112-5211
Phone (206) 326-3530

Other practice location 1

US Naval Hospital Okinawa
PSC 482
Fpo, AP 96362-1600
Phone 01181989717555

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181213001860 WA Practitioner - Family Practice 6800027905 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

125 16TH Ave E
Seattle, WA 98112-5211
Phone (206) 326-2662

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD 60430842WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Sep 10, 2018 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Sep 10, 2018 Accepting new patients

Locations

19379 7th Ave NE
Poulsbo, WA 98370
Phone (360) 394-1000

125 16th Ave E
Seattle, WA 98112
Phone (206) 326-3530

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: jroberts195461@ghc.direct-ci.net

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 3

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": "1311033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1184912628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 16TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125211",
            "telephone_number": "206-326-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 16TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125211",
            "telephone_number": "206-326-3530"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "US Naval Hospital Okinawa",
            "address_2": "PSC 482",
            "address_purpose": "LOCATION",
            "city": "FPO",
            "state": "AP",
            "postal_code": "963621600",
            "country_code": "US",
            "telephone_number": "01181989717555",
            "fax_number": "01181989717206",
            "country_name": "United States",
            "address_type": "MIL"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-19",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD 60430842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "125 16th Ave E",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981125211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.