Individual provider Active NPI

Melissa Roberts, D.O.

  • Family Medicine Physician
  • Schenectady, NY
National Provider Identifier
1497169486
Registry record updated Apr 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
289898 Issued in NY
Practice address
624 McClellan St Ste 101
Schenectady, NY 12304-1020
Phone
(518) 382-2260
Fax
(518) 347-5196
NPI assigned
Jun 17, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 289898 NY Primary

Addresses

Primary practice location

624 McClellan St Ste 101
Schenectady, NY 12304-1020

Mailing address

624 McClellan St Ste 101
Schenectady, NY 12304-1020
Phone (518) 382-2260

Other identifiers 1

IdentifierTypeStateIssuer
04840608MedicaidNY

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20171005001615 NY Practitioner - Family Practice 0941575625 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ellis HospitalGroup PAC ID 5890607410, 250 clinicians

Practice addresses (Care Compare)

624 McClellan St
Schenectady, NY 12304-1020
Phone (518) 382-2260

Hospital & facility affiliations

  • Ellis Hospital Hospital, Schenectady, NY, CCN 330153

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
289898NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ellis Hospital CurrentSince Aug 2, 2017 Accepting new patients

Locations

600 McClellan St
Schenectady, NY 12304
Phone (518) 382-2000

624 McClellan St
Ste 101
Schenectady, NY 12304
Phone (518) 347-5043

624 McClellan St
Schenectady, NY 12304
Phone (518) 347-5113

1101 Nott St
Schenectady, NY 12308
Phone (518) 243-1916

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1402963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523232000000",
    "number": "1497169486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 MCCLELLAN ST STE 101",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-382-2260",
            "fax_number": "518-347-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MCCLELLAN ST STE 101",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-382-2260",
            "fax_number": "518-347-5196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MELISSA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-17",
        "last_updated": "2018-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "289898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04840608",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schenectady, NY

Sources for this page

Verify at the official NPI Registry.