Individual provider Active NPI

Robin L Roberts, D.C.

  • Chiropractor
  • Lincoln Park, MI
National Provider Identifier
1356492995
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301008741 Issued in MI
Practice address
2178 Fort St
Lincoln Park, MI 48146-2405
Phone
(313) 388-9693
Fax
(313) 383-7295
NPI assigned
Jan 12, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301008741 MI Primary

Addresses

Primary practice location

2178 Fort St
Lincoln Park, MI 48146-2405

Mailing address

1409 Wilson Ave
Lincoln Park, MI 48146-2038
Phone (313) 595-9376

Other identifiers 2

IdentifierTypeStateIssuer
7323599OtherMICIGNA PROVIDER #
95 0 H2 1922 0OtherMIBCBS PROVIDER #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040429000594 MI Practitioner - Chiropractic 5092702134 Practice locations: Southgate, MI

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

13301 Reeck CT
Southgate, MI 48195-3054
Phone (734) 282-8484

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Roberts Chiropractic Life Center, PLLC Chiropractor PastSince Jan 1, 1990 Accepting new patients
Roberts Chiropractic Life Center PastSince Jan 1, 1990 Accepting new patients
Beller Chiropractic Life Center, Inc Chiropractor Past Accepting new patients
Lawrence a Gralewski Chiropractor Past Accepting new patients

Organizations & group practices 4

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": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356492995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 WILSON AVE",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462038",
            "telephone_number": "313-595-9376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2178 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462405",
            "telephone_number": "313-388-9693",
            "fax_number": "313-383-7295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "ROBIN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PROVIDER #",
            "identifier": "7323599",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "95 0 H2 1922 0",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln Park, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.