NPIMap

Individual provider Active NPI

Craig R Roberts, MPT

  • Physical Therapist
  • Owensboro, KY
National Provider Identifier
1417054487
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
005392 Issued in KY
Practice address
1605 Scherm Rd
Owensboro, KY 42301-5300
Phone
(270) 685-9499
Fax
(270) 685-9443
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05008190A IN
Physical Therapist 225100000X 005392 KY Primary

Addresses

Primary practice location

1605 Scherm Rd
Owensboro, KY 42301-5300

Mailing address

3026 Hidden Lake PT
Owensboro, KY 42303-4455
Phone (270) 685-9499

Other identifiers 2

IdentifierTypeStateIssuer
000000491496OtherINBLUE CROSS BLUE SHIELD
200839370MedicaidIN

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

State licenses

LicenseStateTypeSpecialty
05008190AINMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Progressive Sports Therapy, LLC. Physical Therapist Past Accepting new patients
Progressive Rehab, Inc. Physical Therapist Past Accepting new patients
Back to Health LLC PastSince Jun 18, 2007 Accepting new patients
Prorehab Inc Physical Therapist Past Accepting new patients

Organizations & group practices 4

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1417054487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3026 HIDDEN LAKE PT",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423034455",
            "telephone_number": "270-685-9499",
            "fax_number": "270-685-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 SCHERM RD",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423015300",
            "telephone_number": "270-685-9499",
            "fax_number": "270-685-9443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "CRAIG",
        "middle_name": "R",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05008190A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "005392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000491496",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200839370",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owensboro, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.