Individual provider Active NPI

Kent G Roberson, M.D.

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1518969237
Registry record updated Oct 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34725 Issued in CO
Practice address
13060 Vollmer Rd
Colorado Springs, CO 80908-6410
Phone
(719) 299-7696
Fax
(719) 299-7696
NPI assigned
Aug 12, 2005
Last updated
Oct 8, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2026

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 34725 CO Primary

Addresses

Primary practice location

13060 Vollmer Rd
Colorado Springs, CO 80908-6410

Mailing address

6547 N Academy Blvd # 212
Colorado Springs, CO 80918-8342
Phone (719) 299-7696

Other identifiers 1

IdentifierTypeStateIssuer
01347251MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20040610000447 CO Practitioner - Family Practice 9032192364 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34725COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Matthews-Vu Medical Group, P.C. Family Medicine CurrentSince Oct 1, 2018 Accepting new patients
Matthews-Vu Medical Group, P.C. CurrentSince Oct 1, 2018 Accepting new patients
Matthews-Vu Medical Group, P.C. Current Accepting new patients
Delta Waves of Woodland Park Inc Past Accepting new patients

Locations

104 Pro Rodeo Dr
Ste 100
Colorado Springs, CO 80919
Phone (719) 522-0707

4190 E Woodmen Rd
Ste 100
Colorado Springs, CO 80920
Phone (630) 328-7971

Organizations & group practices 4

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": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791417600000",
    "number": "1518969237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6547 N ACADEMY BLVD # 212",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809188342",
            "telephone_number": "719-299-7696",
            "fax_number": "719-299-7696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13060 VOLLMER RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809086410",
            "telephone_number": "719-299-7696",
            "fax_number": "719-299-7696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "KENT",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2026-10-08",
        "certification_date": "2026-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "34725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01347251",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.