Active NPI
Jack T. Roberts, AU.D
- Audiologist
- Lorain, OH
National Provider Identifier
1376592667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- A00803
- Practice address
- 1680 Cooper Foster Park Rd W
Suite a
Lorain, OH 44053-3657 - Phone
- (440) 989-1133
- Fax
- (440) 989-1137
- NPI assigned
- May 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | A00803 | OH | Primary |
Addresses
Primary practice location
1680 Cooper Foster Park Rd W
Suite a
Lorain, OH 44053-3657
Mailing address
1680 Cooper Foster Park Rd W
Suite a
Lorain, OH 44053-3657
Phone (440) 989-1133
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0883076 | Medicaid | OH |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A00803 | OH | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apl Associates, LLC | Audiologist | Past | Accepting new patients |
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": "1146873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428451200000",
"number": "1376592667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1680 COOPER FOSTER PARK RD W",
"address_2": "SUITE A",
"city": "LORAIN",
"state": "OH",
"postal_code": "440533657",
"telephone_number": "440-989-1133",
"fax_number": "440-989-1137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1680 COOPER FOSTER PARK RD W",
"address_2": "SUITE A",
"city": "LORAIN",
"state": "OH",
"postal_code": "440533657",
"telephone_number": "440-989-1133",
"fax_number": "440-989-1137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "JACK",
"middle_name": "T.",
"credential": "AU.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-06",
"last_updated": "2015-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "OH",
"license": "A00803",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0883076",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lorain, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.