Active NPI
Jerry D Roberts, OD
- Optometrist
- Scottsburg, IN
National Provider Identifier
1215912464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18001504A
- Practice address
- 279 N Gardner St
Scottsburg, IN 47170 - Phone
- (812) 752-5106
- Fax
- (812) 752-5132
- NPI assigned
- Dec 9, 2005
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18001504A | IN | Primary |
Addresses
Primary practice location
279 N Gardner St
Scottsburg, IN 47170
Mailing address
279 N Gardner St
Scottsburg, IN 47170
Phone (812) 752-5106
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100099460B | Medicaid | IN | |
| 005120 | Other | SIHO | |
| 410010037 | Other | RR MEDICARE | |
| 000000109053 | Other | ANTHEM |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18001504A | IN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Don R Downing J D Roberts & D Barry Downing PTRS | Optometrist | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Optometrist
- Seymour, IN
- NPI 1821085788
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225843200000",
"number": "1215912464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "279 N GARDNER ST",
"city": "SCOTTSBURG",
"state": "IN",
"postal_code": "47170",
"telephone_number": "812-752-5106",
"fax_number": "812-752-5132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "279 N GARDNER ST",
"city": "SCOTTSBURG",
"state": "IN",
"postal_code": "47170",
"telephone_number": "812-752-5106",
"fax_number": "812-752-5132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "JERRY",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-09",
"last_updated": "2008-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18001504A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100099460B",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIHO",
"identifier": "005120",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "410010037",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000109053",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Scottsburg, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.