Individual provider Active NPI

Jamie Roberts, PSY.D.

  • Psychologist
  • Brookfield, WI
National Provider Identifier
1578843405
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3092-57 Issued in WI
Practice address
13800 W North Ave Ste 120
Brookfield, WI 53005-4977
Phone
(262) 432-6600
Fax
(262) 432-6604
NPI assigned
Aug 23, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 3092-57 WI Primary
Counselor 101Y00000X 4636-125 WI

Addresses

Primary practice location

13800 W North Ave Ste 120
Brookfield, WI 53005-4977

Mailing address

13800 W North Ave Ste 120
Brookfield, WI 53005-4977
Phone (262) 432-6600

Other practice location 1

9916 75th St
Kenosha, WI 53142-7583
Phone (262) 942-4000

Other identifiers 1

IdentifierTypeStateIssuer
1578843405MedicaidWI

Other names 1

  • Jamie Radonski Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130524000507 WI Practitioner - Clinical Psychologist 5799923132 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4636-125WIMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. CurrentSince Feb 1, 2021 Accepting new patients

Locations

13800 W North Ave
Ste 120
Brookfield, WI 53005
Phone (262) 432-6600

34700 Valley Rd
Oconomowoc, WI 53066

1701 Sharp Rd
Waterford, WI 53185
Phone (262) 534-7297

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: jroberts87452@direct.chw.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1314057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1578843405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13800 W NORTH AVE STE 120",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054977",
            "telephone_number": "262-432-6600",
            "fax_number": "262-432-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 W NORTH AVE STE 120",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054977",
            "telephone_number": "262-432-6600",
            "fax_number": "262-432-6604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9916 75th St",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531427583",
            "country_code": "US",
            "telephone_number": "262-942-4000",
            "fax_number": "262-942-7740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JAMIE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-23",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3092-57",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "4636-125",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578843405",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAMIE",
            "last_name": "RADONSKI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.