Charles Anthony Roberts Jr., PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00257 Issued in OR

Practice address

87983 Territorial Rd
Veneta, OR 97487

Phone

(541) 935-2200

Fax

(541) 935-6241

NPI assigned

Aug 2, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Icco, LLC

  dba Veneta Medical Clinic

  • Family Medicine Physician
  • Veneta, OR
  • NPI 1518990621
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437166352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 145",
            "city": "VENETA",
            "state": "OR",
            "postal_code": "974870145",
            "telephone_number": "541-935-2200",
            "fax_number": "541-935-6241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87983 TERRITORIAL RD",
            "city": "VENETA",
            "state": "OR",
            "postal_code": "97487",
            "telephone_number": "541-935-2200",
            "fax_number": "541-935-6241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "CHARLES",
        "middle_name": "ANTHONY",
        "name_suffix": "Jr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA00257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mid Lane Cares (Hope Family Health)
• Laurie Miller, LMT
• Brandon L Noble
• Leelah R Perpinan
• Richard P. Snyder, O.D. (Applegate Eye Center, LLC)
• Tracy R Robinson, D.M.D., P.C.
• Matthew Joseph Roseman, DPT
• Clarissa Ruelene Sanders, LMT
• Select Physical Therapy Orthopedic Services Inc
• Matthew A Shaw, MD

• Physician Assistant in Veneta, OR
• Providers in Veneta, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.