James Wallace Robertson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301065685 Issued in MI

Practice address

5024 N Royal Dr
Traverse City, MI 49684-9230

Phone

(231) 935-0555

Fax

(231) 935-0562

NPI assigned

Jun 22, 2005

Last updated

Dec 24, 2020By 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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Pediatric Medicine

Education

Michigan State University College of Human Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kids Creek Childrens Clinic PCGroup PAC ID 2264977693, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HBICCA
• Direct secure messaging: james.robertson@kccc.eclinicaldirectplus.com
• Direct secure messaging: jrobertson129009@mymichiganhealth.midirect.net

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.

• Kids Creek Childrens Clinic PC

  • Pediatrics Physician
  • Traverse City, MI
  • NPI 1649291832
  Medicare reassignment Care Compare group NPD
• Helen Newberry Joy Hospital & Healthcare Center

  dba Manistique Lakes Family Clinic

  • Rural Health Clinic/Center
  • Curtis, MI
  • NPI 1972650935
  Medicare reassignment NPD
• Munson Healthcare Grayling

  dba Roscommon Community Health Center

  • Rural Health Clinic/Center
  • Roscommon, MI
  • NPI 1710383351
  Medicare reassignment NPD
• Helen Newberry Joy Hospital & Healthcare Center

  dba HNJH - Skilled Care

  • Nursing Facility/Intermediate Care Facility
  • Newberry, MI
  • NPI 1164545323
  NPD
• Helen Newberry Joy Hospital & Healthcare Center

  • Critical Access Hospital
  • Newberry, MI
  • NPI 1497742050
  NPD
• Munson Healthcare Grayling

  dba Mio Primary Care

  • Rural Health Clinic/Center
  • Mio, MI
  • NPI 1093349698
  NPD
• Munson Healthcare Grayling

  dba Grayling Community Health Center

  • Rural Health Clinic/Center
  • Grayling, MI
  • NPI 1891191698
  NPD
• Munson Healthcare Charlevoix Hospital

  dba Munson Healthcare Charlevoix Pediatrics

  • Rural Health Clinic/Center
  • Charlevoix, MI
  • NPI 1326681461
  NPD (past)
• Munson Medical Center

  • General Acute Care Hospital
  • Traverse City, MI
  • NPI 1952307852
  NPD (past)

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608768000000",
    "number": "1457357832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5024 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849230",
            "telephone_number": "231-935-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5024 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849230",
            "telephone_number": "231-935-0555",
            "fax_number": "231-935-0562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "829 N Center Ave Ste 130",
            "address_purpose": "LOCATION",
            "city": "Gaylord",
            "state": "MI",
            "postal_code": "497351684",
            "country_code": "US",
            "telephone_number": "989-731-7930",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14719 W Upright St",
            "address_purpose": "LOCATION",
            "city": "Charlevoix",
            "state": "MI",
            "postal_code": "497201949",
            "country_code": "US",
            "telephone_number": "231-547-3840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1250 E Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Grayling",
            "state": "MI",
            "postal_code": "497387074",
            "country_code": "US",
            "telephone_number": "989-348-0550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "JAMES",
        "middle_name": "WALLACE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2020-12-24",
        "certification_date": "2020-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301065685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1065685",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "James.Robertson@kccc.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "5024 N Royal Dr",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496849230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert D Barger, MD, PC
• Robert M Dotterrer MD
• Victoria Roberts-Jamison
• Brandon Roberts, DPT
• Amy Denise Robertson, MD
• Paula K Robey, P.A.
• Kelsea Robinson
• Rita Sue Robinson, PT
• Rocketship Physical Therapy
• Jana L Rockne, LPC, LMFT

• Pediatrics Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.