NPIMap

Individual provider Active NPI

Mark A Roberts, MD

  • Family Medicine Physician
  • Evergreen, AL
National Provider Identifier
1275565442
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15010 Issued in AL
Practice address
106 Edwina Street
Evergreen, AL 36401
Phone
(251) 578-4300
Fax
(251) 578-4307
NPI assigned
Jul 7, 2006
Last updated
Jun 13, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 15010 AL Primary
Pain Medicine Physician 208VP0000X PM.282 AL
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X 15010 AL

Addresses

Primary practice location

106 Edwina Street
Evergreen, AL 36401

Mailing address

106 Edwina Street
Evergreen, AL 36401
Phone (251) 578-4300

Other practice location 1

11766 County Road 6
Castleberry, AL 36432-5116
Phone (251) 966-5210

Other identifiers 1

IdentifierTypeStateIssuer
051558849MedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070625000235 AL Practitioner - Family Practice 8022117506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mark a Roberts MD PCGroup PAC ID 2365541844, 3 clinicians

Practice addresses (Care Compare)

106 Edwina St
Evergreen, AL 36401-3319
Phone (251) 578-4300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal or shaving of skin growth17

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PM.282ALMDPain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mark a Roberts MD PC Family Medicine CurrentSince May 1, 2007 Accepting new patients
Evergreen Nursing Home, LLC Past Accepting new patients
Evergreen Medical Center LLC Past Accepting new patients

Locations

106 Edwina St
Evergreen, AL 36401
Phone (251) 578-4300

Interoperability endpoints

  • Direct secure messaging: mark.roberts@markrob.direct.medconnect-inc.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1275565442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 EDWINA STREET",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "36401",
            "telephone_number": "251-578-4300",
            "fax_number": "251-578-4307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 EDWINA STREET",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "36401",
            "telephone_number": "251-578-4300",
            "fax_number": "251-578-4307"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11766 County Road 6",
            "address_purpose": "LOCATION",
            "city": "Castleberry",
            "state": "AL",
            "postal_code": "364325116",
            "country_code": "US",
            "telephone_number": "251-966-5210",
            "fax_number": "251-220-5163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "15010",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "AL",
            "license": "PM.282",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "AL",
            "license": "15010",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051558849",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen, AL

Sources for this page

Verify at the official NPI Registry.