Active NPI
Jodee M Roberts, LAT, ATC
- Athletic Trainer
- Centralia, WA
National Provider Identifier
1578068110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 813 Eshom Rd
Centralia, WA 98531-1515 - Phone
- (360) 330-7605
- NPI assigned
- Mar 27, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
813 Eshom Rd
Centralia, WA 98531-1515
Mailing address
19928 Kuper CT
Centralia, WA 98531-9665
Phone (509) 741-0414
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2000014984 | Other | WA | BOC CERTIFICATION NUMBER |
| 48449 | Other | NATA MEMBERSHIP NUMBER |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522108800000",
"number": "1578068110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19928 KUPER CT",
"city": "CENTRALIA",
"state": "WA",
"postal_code": "985319665",
"telephone_number": "509-741-0414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "813 ESHOM RD",
"city": "CENTRALIA",
"state": "WA",
"postal_code": "985311515",
"telephone_number": "360-330-7605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "JODEE",
"middle_name": "M",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-27",
"last_updated": "2018-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOC CERTIFICATION NUMBER",
"identifier": "2000014984",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATA MEMBERSHIP NUMBER",
"identifier": "48449",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Centralia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.