Active NPI
Heather I. Robertson, PA
- Physician Assistant
- Leeds, ME
National Provider Identifier
1467452185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA1472
- Practice address
- 180 Church Hill Rd
Suite 1
Leeds, ME 04263-3418 - Phone
- (207) 524-3501
- Fax
- (207) 524-2459
- NPI assigned
- Jul 22, 2005
- Last updated
- Jun 25, 2021
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110002587 | VA | |
| Physician Assistant | 363A00000X | MA003586L | PA | |
| Physician Assistant | 363A00000X | PA1472 | ME | Primary |
Addresses
Primary practice location
180 Church Hill Rd
Suite 1
Leeds, ME 04263-3418
Mailing address
180 Church Hill Rd
Suite 1
Leeds, ME 04263-3418
Phone (207) 524-3501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467452185 | Medicaid | ME |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA003586L | PA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inova Health Care Services | 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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624579200000",
"number": "1467452185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 CHURCH HILL RD",
"address_2": "SUITE 1",
"city": "LEEDS",
"state": "ME",
"postal_code": "042633418",
"telephone_number": "207-524-3501",
"fax_number": "207-524-2459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 CHURCH HILL RD",
"address_2": "SUITE 1",
"city": "LEEDS",
"state": "ME",
"postal_code": "042633418",
"telephone_number": "207-524-3501",
"fax_number": "207-524-2459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "HEATHER",
"middle_name": "I.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-22",
"last_updated": "2021-06-25",
"certification_date": "2021-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110002587",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA003586L",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ME",
"license": "PA1472",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1467452185",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leeds, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.