Individual provider Active NPI

Timothy G Roberts, MD

  • Psychiatry Physician
  • Champaign, IL
National Provider Identifier
1275668238
Registry record updated Apr 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036070267 Issued in IL
Practice address
1813 W. Kirby Ave.
Champaign, IL 61821-5410
Phone
(217) 383-1850
Fax
(217) 383-1101
NPI assigned
Feb 22, 2007
Last updated
Apr 21, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036070267 IL Primary

Addresses

Primary practice location

1813 W. Kirby Ave.
Champaign, IL 61821-5410

Mailing address

611 W. Park St.
BWPC
Urbana, IL 61801-2500
Phone (217) 383-6792

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20100601000698 IL Practitioner - Psychiatry 3577692573 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Southern Illinois University School of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

1802 S Mattis Ave
Champaign, IL 61821-5923
Phone (217) 326-1330

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036070267ILMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Apr 1, 2010 Accepting new patients

Locations

1813 W Kirby Ave
Champaign, IL 61821
Phone (217) 383-1850

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

810 W Anthony Dr
Urbana, IL 61802
Phone (217) 326-2911

Interoperability endpoints

  • Direct secure messaging: trobertsmd129398@carlehiedirect.net

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429574400000",
    "number": "1275668238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W. PARK ST.",
            "address_2": "BWPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012500",
            "telephone_number": "217-383-6792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W. KIRBY AVE.",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215410",
            "telephone_number": "217-383-1850",
            "fax_number": "217-383-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "TIMOTHY",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2015-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036070267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.