NPIMap

Individual provider Active NPI

Robert Oscar Robertson, DO

  • Family Medicine Physician
  • Jackson, MI
National Provider Identifier
1336137892
Registry record updated Oct 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101007194 Issued in MI
Practice address
300 W Washington Ave
Ste 150
Jackson, MI 49201-2180
Phone
(517) 783-4664
Fax
(517) 783-4698
NPI assigned
Oct 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101007194 MI Primary

Addresses

Primary practice location

300 W Washington Ave
Ste 150
Jackson, MI 49201-2180

Mailing address

300 W Washington Ave
Ste 150
Jackson, MI 49201-2180
Phone (517) 783-4664

Other identifiers 3

IdentifierTypeStateIssuer
P62172OtherAETNA
1744106MedicaidMI
700C86358OtherMIBCBS

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
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
John F Smarch DC PC PastSince Mar 1, 2005 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: rrobertson462893@direct.hfhs.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317686400000",
    "number": "1336137892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W WASHINGTON AVE",
            "address_2": "STE 150",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012180",
            "telephone_number": "517-783-4664",
            "fax_number": "517-783-4698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W WASHINGTON AVE",
            "address_2": "STE 150",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012180",
            "telephone_number": "517-783-4664",
            "fax_number": "517-783-4698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "ROBERT",
        "middle_name": "OSCAR",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2011-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101007194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "P62172",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1744106",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "700C86358",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; 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.