Active NPI
John Andrew Robertson, M.D.
- Nephrology Physician
- Riverside, CA
National Provider Identifier
1528019536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- G54428
- Practice address
- 3660 Park Sierra Dr
Suite 208
Riverside, CA 92505-3071 - Phone
- (951) 687-2800
- Fax
- (951) 687-7290
- NPI assigned
- May 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | G54428 | CA | Primary |
Addresses
Primary practice location
3660 Park Sierra Dr
Suite 208
Riverside, CA 92505-3071
Mailing address
PO Box 54130
Los Angeles, CA 90054-0130
Phone (951) 687-3400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G544280 | Medicaid | CA |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G54428 | CA | MD | Nephrology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Noster Dialysis LLC | Past | Accepting new patients | |
| Nephrology Associates Medical Group, Inc. | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- john.robertson.1@19859.direct.athenahealth.com
Organizations & group practices 2
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.
-
- Specialist
- Riverside, CA
- NPI 1093264145
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Jurupa Valley, CA
- NPI 1881085900
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325635200000",
"number": "1528019536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 54130",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900540130",
"telephone_number": "951-687-3400",
"fax_number": "951-687-7630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3660 PARK SIERRA DR",
"address_2": "SUITE 208",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925053071",
"telephone_number": "951-687-2800",
"fax_number": "951-687-7290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "JOHN",
"middle_name": "ANDREW",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-15",
"last_updated": "2012-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "CA",
"license": "G54428",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G544280",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.