Individual provider Active NPI

James M Roberts, OTR/L, OTD

  • Occupational Therapist
  • Anacortes, WA
National Provider Identifier
1487266508
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT61311258 Issued in WA
Practice address
1017 20TH St
Anacortes, WA 98221-2505
Phone
(360) 424-7041
Fax
(360) 424-2456
NPI assigned
Aug 19, 2020
Last updated
Apr 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT61311258 WA Primary
Hand Occupational Therapist 225XH1200X OT61311258 WA

Addresses

Primary practice location

1017 20TH St
Anacortes, WA 98221-2505

Mailing address

1401 S Laventure Rd
Mount Vernon, WA 98274-6033
Phone (360) 424-7041

Other practice location 1

1401 S Laventure Rd
Mount Vernon, WA 98274-6033
Phone (360) 424-7041

Other names 1

  • Jimmy M Roberts Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220723000089 WA Practitioner - Occupational Therapist in Private Practice 7618397282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

1017 20TH St
Anacortes, WA 98221-2505
Phone (360) 424-7041

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT61311258WAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Current Accepting new patients
Proliance Surgeons Inc P S CurrentSince Mar 4, 2024 Accepting new patients
Proliance Surgeons Inc P S CurrentSince Mar 4, 2024 Accepting new patients

Locations

1017 20th St
Anacortes, WA 98221
Phone (360) 424-7041

1401 S Laventure Rd
Mount Vernon, WA 98274
Phone (360) 424-2400

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Organizations & group practices 3

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": "1597795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1487266508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S LAVENTURE RD",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982746033",
            "telephone_number": "360-424-7041",
            "fax_number": "360-424-2456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 20TH ST",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212505",
            "telephone_number": "360-424-7041",
            "fax_number": "360-424-2456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 S Laventure Rd",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "WA",
            "postal_code": "982746033",
            "country_code": "US",
            "telephone_number": "360-424-7041",
            "fax_number": "360-424-2456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JAMES",
        "middle_name": "M",
        "credential": "OTR/L, OTD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-19",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT61311258",
            "primary": true
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "WA",
            "license": "OT61311258",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JIMMY",
            "last_name": "ROBERTS",
            "middle_name": "M",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Anacortes, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.