Active NPI
Amy Denise Robertson, MD
- Internal Medicine Physician
- Traverse City, MI
National Provider Identifier
1437142791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301097465
- Practice address
- 1105 Sixth St
Traverse City, MI 49684-2345 - Phone
- (231) 935-5000
- Fax
- (231) 922-9271
- NPI assigned
- Aug 23, 2005
- Last updated
- Sep 17, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 2002-00067 | NC | |
| Internal Medicine Physician | 207R00000X | 4301097465 | MI | Primary |
Addresses
Primary practice location
1105 Sixth St
Traverse City, MI 49684-2345
Mailing address
PO Box 107
Traverse City, MI 49685-0107
Phone (231) 922-9270
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8913128 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301097465 | MI | MD | Internal Medicine Physician |
| 2002-00067 | NC | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indigo Services, PLC | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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": "1284681600000",
"number": "1437142791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 107",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496850107",
"telephone_number": "231-922-9270",
"fax_number": "231-922-9271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 SIXTH ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842345",
"telephone_number": "231-935-5000",
"fax_number": "231-922-9271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "AMY",
"middle_name": "DENISE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-23",
"last_updated": "2010-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NC",
"license": "2002-00067",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301097465",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8913128",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.