Individual provider Active NPI

Megan Roberts

  • Pediatric Nurse Practitioner
  • Waterloo, IL
National Provider Identifier
1285403600
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
209.029130 Issued in IL
Practice address
224 Bradford LN
Waterloo, IL 62298-3369
Phone
(618) 939-0112
NPI assigned
Dec 27, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 209.029130 IL Primary

Addresses

Primary practice location

224 Bradford LN
Waterloo, IL 62298-3369

Mailing address

146 Bollinger St
Glen Carbon, IL 62034-1511

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)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.029130ILMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Heart to Heart Pediatrics LLC Pediatrics CurrentSince Dec 31, 2023 Accepting new patients

Locations

224 Bradford Ln
Waterloo, IL 62298
Phone (618) 939-0112

224 Bradford Ln
Ste A
Waterloo, IL 62298
Phone (618) 939-8190

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21224/brand/1/csg/1/fhir/r4

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": "1703635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1285403600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 BOLLINGER ST",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 BRADFORD LN",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622983369",
            "telephone_number": "618-939-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MEGAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-27",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209.029130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.