NPIMap

Organization Active NPI

Douglas E Roberts Jr MD a Professional Corporation

Doing business as Heather Stone Medical Clinic

  • Internal Medicine Physician
  • Ridgecrest, CA
National Provider Identifier
1386899268
Registry record updated Oct 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DOUGLAS E ROBERTS JR MD A PROFESSIONAL CORPORATION
Doing business as
Heather Stone Medical Clinic
Practice address
900 N Heritage Dr
BLDG E
Ridgecrest, CA 93555-5536
Phone
(760) 446-4571
NPI assigned
Nov 19, 2008
Last updated
Oct 30, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2014

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

Authorized official

Name
Dr. Douglas Emanuel Roberts Jr., M.D.NPI 1508869926
Title
President
Phone
(760) 446-4571

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

900 N Heritage Dr
BLDG E
Ridgecrest, CA 93555-5536

Mailing address

900 N Heritage Dr
BLDG E
Ridgecrest, CA 93555-5536
Phone (760) 446-4571

Other names 1

  • Heather Stone Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090923000324 CA Part B Supplier - Clinic/Group Practice 8921154592 Receives reassigned benefits from 8 practitioners
Practice locations: Ridgecrest, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2002894Heather Stone Medical Clinic900 North Heritage Drive, BLDG E, Ridgecrest, CA 93555Certificate of waiverJan 27, 2028

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17265/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414627200000",
    "number": "1386899268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N HERITAGE DR",
            "address_2": "BLDG E",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935555536",
            "telephone_number": "760-446-4571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N HERITAGE DR",
            "address_2": "BLDG E",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935555536",
            "telephone_number": "760-446-4571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS E ROBERTS JR MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-19",
        "last_updated": "2014-10-30",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "EMANUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-446-4571",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heather Stone Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ridgecrest, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; 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.