Active NPI
Jon D Roberts, MD
- Emergency Medicine Physician
- Columbia, MO
National Provider Identifier
1265420178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 110556
- Practice address
- 1600 E Broadway
Columbia, MO 65201-5844 - Phone
- (573) 815-3573
- Fax
- (573) 445-7285
- NPI assigned
- Oct 13, 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 110556 | MO | Primary |
Addresses
Primary practice location
1600 E Broadway
Columbia, MO 65201-5844
Mailing address
1123 Wilkes Blvd
Suite 120
Columbia, MO 65201
Phone (573) 445-7272
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203932207 | Medicaid | MO |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110556 | MO | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278979200000",
"number": "1265420178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1123 WILKES BLVD",
"address_2": "SUITE 120",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "65201",
"telephone_number": "573-445-7272",
"fax_number": "573-445-7285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 E BROADWAY",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652015844",
"telephone_number": "573-815-3573",
"fax_number": "573-445-7285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "JON",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-13",
"last_updated": "2010-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MO",
"license": "110556",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "203932207",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.