Kim Roberts

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10507 Issued in AZ

Practice address

3212 N Windsong Dr FL 2
Prescott Valley, AZ 86314-2255

Phone

(928) 583-1000

NPI assigned

Dec 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• County of Yavapai

  • Public Health or Welfare Agency
  • Prescott Valley, AZ
  • NPI 1336265982
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1508928169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "476 NORTH 900 WEST",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "84003",
            "telephone_number": "801-756-5522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3212 N WINDSONG DR FL 2",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142255",
            "telephone_number": "928-583-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KIM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "10507",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "142369-9922",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Sinsheimer MD PLLC
• Robert Thadeus Management Corp
• Charles Roberts
• Chezzaree Roberts
• Heather Leann Roberts, PHARMD, RPH
• Linda Beth Roberts, PA-C
• Sharon Ann Roberts
• Pamela Lynn Robinette, RN
• Rocky Mountain Holdings, LLC
• Maureen A Roessler, M.S., CCC-SLP

• General Practice Dentistry in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.