Individual provider Active NPI

Joel Roberts, NP

  • Primary Care Nurse Practitioner
  • Woodburn, OR
National Provider Identifier
1255921177
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
202010988NP Issued in OR
Practice address
105 Arney Rd Ste 130
Woodburn, OR 97071-9472
Phone
(503) 902-3900
NPI assigned
Jan 25, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 202010988NP OR Primary
Nurse Practitioner 363L00000X 202010988NP-PP OR

Addresses

Primary practice location

105 Arney Rd Ste 130
Woodburn, OR 97071-9472

Mailing address

105 Arney Rd Ste 130
Woodburn, OR 97071-9472
Phone (503) 902-3900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210924001919 OR Practitioner - Nurse Practitioner 2466859095 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Salem HealthGroup PAC ID 8628986668, 470 clinicians

Practice addresses (Care Compare)

1000 SE Uglow Ave
Dallas, OR 97338-2645
Phone (503) 623-8376

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
202010988NPORMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Health West Valley CurrentSince Sep 13, 2021 Accepting new patients
Salem Health CurrentSince Sep 13, 2021 Accepting new patients
Salem Health CurrentSince Sep 13, 2021 Accepting new patients

Locations

1000 SE Uglow Ave
Dallas, OR 97338
Phone (503) 623-8376

1601 Monmouth St
Ste 100
Independence, OR 97351
Phone (503) 623-8301

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

105 Arney Rd
Ste 130
Woodburn, OR 97071
Phone (503) 902-3900

Organizations & group practices 3

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 4

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": "1611532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1255921177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 ARNEY RD STE 130",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719472",
            "telephone_number": "503-902-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 ARNEY RD STE 130",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719472",
            "telephone_number": "503-902-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JOEL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-25",
        "last_updated": "2023-12-14",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OR",
            "license": "202010988NP",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "202010988NP-PP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodburn, OR

Sources for this page

Verify at the official NPI Registry.