Individual provider Active NPI

Lester Robertson, P.A.- C

  • Surgical Physician Assistant
  • Newport Beach, CA
National Provider Identifier
1386033017
Registry record updated Jan 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
51465 Issued in CA
Practice address
3991 Macarthur Blvd
Suite 320
Newport Beach, CA 92660-3009
Phone
(949) 720-3888
Fax
(714) 902-1101
NPI assigned
Jan 19, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 51465 CA Primary

Addresses

Primary practice location

3991 Macarthur Blvd
Suite 320
Newport Beach, CA 92660-3009

Mailing address

3991 Macarthur Blvd
Suite 320
Newport Beach, CA 92660-3009
Phone (949) 720-3888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151105002662 CA Practitioner - Physician Assistant 1355651118 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
51465CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
The Medcenter, Inc. CurrentSince Sep 29, 2015 Accepting new patients
The Medcenter, Inc. Current Accepting new patients

Organizations & group practices 3

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": "1421625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421625600000",
    "number": "1386033017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3991 MACARTHUR BLVD",
            "address_2": "SUITE 320",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926603009",
            "telephone_number": "949-720-3888",
            "fax_number": "714-902-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3991 MACARTHUR BLVD",
            "address_2": "SUITE 320",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926603009",
            "telephone_number": "949-720-3888",
            "fax_number": "714-902-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "LESTER",
        "name_prefix": "Mr.",
        "credential": "P.A.- C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-19",
        "last_updated": "2015-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "51465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.