NPIMap

Individual provider Active NPI

Keith A Roberts, OD

  • Optometrist
  • Chicago, IL
National Provider Identifier
1356590525
Registry record updated Jun 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18003510A Issued in IN
Practice address
5855 Reliable Pkwy
Chicago, IL 60686-0001
Phone
(812) 288-2029
Fax
(502) 736-4490
NPI assigned
Sep 12, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1735DT KY
Optometrist 152W00000X 18003510A IN Primary

Addresses

Primary practice location

5855 Reliable Pkwy
Chicago, IL 60686-0001

Mailing address

5855 Reliable Parkway
Chicago, IL 60686-0058
Phone (812) 288-2029

Other identifiers 2

IdentifierTypeStateIssuer
7100079400MedicaidKY
200922030MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20081014000697 IN Practitioner - Optometry 0547338832 Reassigns benefits to 1 organization
I20081021000767 KY Practitioner - Optometry 0547338832 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Precision Family Eye CareGroup PAC ID 9032341367, 2 clinicians

Practice addresses (Care Compare)

409 Lafollette Sta N
Floyds Knobs, IN 47119-9780
Phone (812) 728-8163

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18003510AINMDOptometrist
1735DTKYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Tri-State Doctors of Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Tri-State Doctors of Optometrist Past Accepting new patients

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276473600000",
    "number": "1356590525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 RELIABLE PARKWAY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860058",
            "telephone_number": "812-288-2029",
            "fax_number": "502-736-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5855 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860001",
            "telephone_number": "812-288-2029",
            "fax_number": "502-736-4490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KEITH",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-12",
        "last_updated": "2010-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1735DT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003510A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100079400",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200922030",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.