Active NPI
Shirley J Robertson, MD
- Family Medicine Physician
- Lansing, MI
National Provider Identifier
1396849667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- SR036051
- Practice address
- 1540 Lake Lansing Rd
Suite 102
Lansing, MI 48912-3756 - Phone
- (517) 913-3810
- Fax
- (517) 913-3811
- NPI assigned
- Sep 8, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | SR036051 | MI | Primary |
Addresses
Primary practice location
1540 Lake Lansing Rd
Suite 102
Lansing, MI 48912-3756
Mailing address
1540 Lake Lansing Rd
Suite 102
Lansing, MI 48912-3756
Phone (517) 913-3810
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4452231 | Other | MI | AETNA |
| 0M21440057 | Other | MI | MEDICARE ADVANTAGE |
| 1021672 | Other | MI | MCLAREN HEALTH PLAN-MEDICAID |
| 200000002859 | Other | MI | PHP |
| 1021672 | Other | MI | MCLAREN HEALTH ADVANTAGE |
| 4926050 | Medicaid | MI | |
| 0803307571 | Other | MI | BLUE CROSS BLUE SHIELD |
| 0803307571 | Other | MI | BLUE CARE NETWORK |
| 1021672 | Other | MI | MCLAREN HEALTH PLAN-COMMERCIAL |
| 200000002622 | Other | MI | PHP FAMILYCARE |
| 4397827 | Medicaid | MI |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SR036051 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254960000000",
"number": "1396849667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1540 LAKE LANSING RD",
"address_2": "SUITE 102",
"city": "LANSING",
"state": "MI",
"postal_code": "489123756",
"telephone_number": "517-913-3810",
"fax_number": "517-913-3811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 LAKE LANSING RD",
"address_2": "SUITE 102",
"city": "LANSING",
"state": "MI",
"postal_code": "489123756",
"telephone_number": "517-913-3810",
"fax_number": "517-913-3811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "SHIRLEY",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-08",
"last_updated": "2009-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "SR036051",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4452231",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ADVANTAGE",
"identifier": "0M21440057",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN-MEDICAID",
"identifier": "1021672",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP",
"identifier": "200000002859",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH ADVANTAGE",
"identifier": "1021672",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4926050",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0803307571",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "0803307571",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN-COMMERCIAL",
"identifier": "1021672",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP FAMILYCARE",
"identifier": "200000002622",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4397827",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lansing, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.