Individual provider Active NPI

Michelle Roberts

  • Speech-Language Pathologist
  • Chicago, IL
National Provider Identifier
1396250296
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
242.004609 Issued in IL
Practice address
675 N Saint Clair St Ste 15-200
Chicago, IL 60611-5967
Phone
(312) 694-0285
NPI assigned
Dec 13, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 242.004609 IL Primary

Addresses

Primary practice location

675 N Saint Clair St Ste 15-200
Chicago, IL 60611-5967

Mailing address

3125 W Fullerton Ave Apt 214
Chicago, IL 60647-6959
Phone (918) 740-7768

Other practice location 1

73 W Monroe St
Chicago, IL 60603-4955
Phone (312) 870-0352

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190620000458 IL Practitioner - Qualified Speech Language Pathologist 3678807989 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chicago Nasal and Sinus Center S CGroup PAC ID 1254333867, 3 clinicians

Practice addresses (Care Compare)

111 W Washington St
Suite 903
Chicago, IL 60602-2762
Phone (312) 372-9355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
242.004609ILMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Authentic Voice & Speech LLC Speech-Language Pathologist Current Accepting new patients

Organizations & group practices 2

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": "1513123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560297600000",
    "number": "1396250296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 W FULLERTON AVE APT 214",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606476959",
            "telephone_number": "918-740-7768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 15-200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115967",
            "telephone_number": "312-694-0285"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "73 W Monroe St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606034955",
            "country_code": "US",
            "telephone_number": "312-870-0352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-13",
        "last_updated": "2019-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242.004609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; 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.