Active NPI
Megan Roberts
- Pediatric Nurse Practitioner
- Waterloo, IL
National Provider Identifier
1285403600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 209.029130
- 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
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 |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 209.029130 | IL | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heart to Heart Pediatrics LLC | Pediatrics | Current | 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
- 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.