John Randall Roberts, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12008137 Issued in IN

Practice address

724 N Grand Ave
Connersville, IN 47331-2015

Phone

(765) 825-2051

Fax

(765) 825-2091

NPI assigned

Dec 27, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 31, 2015 through Dec 31, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Eastern Indiana Pediatric Dentistry, LLC

  • Pediatric Dentistry
  • Connersville, IN
  • NPI 1760616114
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1285799395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 N GRAND AVE",
            "city": "CONNERSVILLE",
            "state": "IN",
            "postal_code": "473312015",
            "telephone_number": "765-825-2051",
            "fax_number": "765-825-2091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 N GRAND AVE",
            "city": "CONNERSVILLE",
            "state": "IN",
            "postal_code": "473312015",
            "telephone_number": "765-825-2051",
            "fax_number": "765-825-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JOHN",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Resource Anesthesiology Associates of in LLC
• Richard Wiener, O.D.
• Amanda Lee Richardson
• Gretchen Marie Ritter, MSW, LSW
• Blythe Joy Robbins, DDS
• Sarah Roberts, LCSW
• Gary Robertson
• Roll With US,LLC.
• Katie N Rowland, FNP-BC
• Mary Elizabeth Rummel, FNP

• General Practice Dentistry in Connersville, IN
• Providers in Connersville, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.