Mark Roberts

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN.CNP.0027441 Issued in OH

Practice address

122 Wyoming St
Dayton, OH 45409-2731

Phone

(937) 223-4461

Fax

(937) 449-7603

NPI assigned

Nov 23, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Cincinnati College of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Janda Health and Wellness Services, LLCGroup PAC ID 6507237849, 3 clinicians

Med Management Indiana PCGroup PAC ID 5698027266, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/10693/brand/1/csg/1/fhir/r4
• Direct secure messaging: hnk8372f@yourcarecommunity.org

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.

• J&a Health and Wellness Services, LLC

  • Adult Mental Health Clinic/Center
  • Beavercreek, OH
  • NPI 1992421523

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Med Management Indiana PC

  • Psychiatry Physician
  • Garfield Heights, OH
  • NPI 1225519333

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Premier Health Specialists Inc

  • Internal Medicine Physician
  • Moraine, OH
  • NPI 1194958223

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Clincare International Center LTD

  • Internal Medicine Physician
  • Beavercreek, OH
  • NPI 1174914683

  Multi-Specialty

  Medicare reassignment NPD
• Dayton Lung and Sleep Medicine Inc

  • Pulmonary Disease Physician
  • Englewood, OH
  • NPI 1982621751

  Multi-Specialty

  Medicare reassignment NPD
• Woodstream Wellness

  • Psychiatric/Mental Health Nurse Practitioner
  • Miamisburg, OH
  • NPI 1265001234

  Multi-Specialty

  Medicare reassignment NPD
• Clincare International Center LTD

  • Home Health Agency
  • Beavercreek, OH
  • NPI 1588119432
  NPD
• Premier Health Specialists Inc

  • Foot & Ankle Surgery Podiatrist
  • Dayton, OH
  • NPI 1902211287

  Multi-Specialty

  NPD
• WS Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Miamisburg, OH
  • NPI 1225710668

  Multi-Specialty

  NPD
• Premier Heart Associates, Inc

  • Cardiovascular Disease Physician
  • Beavercreek, OH
  • NPI 1538188735

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1385164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1588094825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1846 SPINDLETOP LN",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454586501",
            "telephone_number": "937-991-3188",
            "fax_number": "937-223-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 WYOMING ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092731",
            "telephone_number": "937-223-4461",
            "fax_number": "937-449-7603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-23",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN151753-M-IV",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.0027441",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0027441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0424687",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Connie Sue Roberts
• Janis A Roberts, DO
• Jeffrey B Roberts
• Lila J Roberts
• Madison Roberts
• Melinda Roberts
• Michelle Roberts
• Renee C Roberts, DPT
• Sarah Roberts
• Stephanie Gail Roberts, LPN

• Psychiatric/Mental Health Nurse Practitioner in Dayton, OH
• Providers in Dayton, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.