Michele L Roberts, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

008500878 Issued in IL

Practice address

21193 Malta Rd
Malta, IL 60150-9600

Phone

(815) 752-3253

Fax

(815) 752-3277

NPI assigned

Feb 14, 2006

Last updated

May 19, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Michelle Smith Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Center for Family Health - Malta

  • Rural Health Clinic/Center
  • Malta, IL
  • NPI 1760729925
  NPD

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495152000000",
    "number": "1376517722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13539 IL ROUTE 76",
            "city": "POPLAR GROVE",
            "state": "IL",
            "postal_code": "610658832",
            "telephone_number": "815-765-0147",
            "fax_number": "815-765-0427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21193 MALTA RD",
            "city": "MALTA",
            "state": "IL",
            "postal_code": "601509600",
            "telephone_number": "815-752-3253",
            "fax_number": "815-752-3277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MICHELE",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-14",
        "last_updated": "2017-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "008500878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "SMITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marissa Nicole Maeder
• Malta Family Dental LLC
• Malta Fire Protection District
• Northern Illinois University (TriCounty Community Health Center)
• Jill Reiland, OTR/L

• Physician Assistant in Malta, IL
• Providers in Malta, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2017; 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.