Individual provider Active NPI

Michael Andrew Roberts, MD

  • Ophthalmology Physician
  • Glendale, CA
National Provider Identifier
1396738530
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
A77138 Issued in CA
Practice address
1510 S Central Ave Ste 100
Glendale, CA 91204-2582
Phone
(213) 483-2416
Fax
(213) 483-8211
NPI assigned
Aug 23, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X A77138 CA Primary

Addresses

Primary practice location

1510 S Central Ave Ste 100
Glendale, CA 91204-2582

Mailing address

1510 S Central Ave Ste 100
Glendale, CA 91204-2582
Phone (213) 483-2416

Other identifiers 1

IdentifierTypeStateIssuer
00A771380MedicaidCA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040908001626 CA Practitioner - Ophthalmology 0749256931 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Southern California Keck School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1510 S Central Ave
Suite 100
Glendale, CA 91204-2582
Phone (213) 483-2416

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
77138CAMDPharmacist
A77138CAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthcare Partners Affiliates Medical Group Ophthalmology Current Accepting new patients
Michael Andrew Roberts, M.D., Inc., a Professional Corporation Ophthalmology CurrentSince Apr 17, 2009 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Jan 9, 2006 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Jan 9, 2006 Accepting new patients
Pih Health Good Samaritan Hospital Past Accepting new patients
Dignity Community Care Past Accepting new patients

Locations

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

716 W Broadway
Glendale, CA 91204
Phone (818) 243-9999

1510 S Central Ave
Ste 100
Glendale, CA 91204
Phone (818) 240-1820

1025 W Olympic Blvd
Los Angeles, CA 90015
Phone (213) 623-2225

201 S Alvarado St
Ste 406
Los Angeles, CA 90057
Phone (213) 483-2416

2601 Via Campo
Montebello, CA 90640
Phone (323) 720-1144

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 6

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": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1396738530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S CENTRAL AVE STE 100",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042582",
            "telephone_number": "213-483-2416",
            "fax_number": "213-483-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S CENTRAL AVE STE 100",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042582",
            "telephone_number": "213-483-2416",
            "fax_number": "213-483-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MICHAEL",
        "middle_name": "ANDREW",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A77138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A771380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.