Individual provider Active NPI

Jordan Andrew Roberts, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Covington, LA
National Provider Identifier
1598024986
Registry record updated Jul 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
308024 Issued in LA
Practice address
95 Judge Tanner Blvd
Covington, LA 70433-7500
Phone
(985) 867-4046
NPI assigned
May 7, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 566797 TX
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 308024 LA Primary

Addresses

Primary practice location

95 Judge Tanner Blvd
Covington, LA 70433-7500

Mailing address

PO Box 3780
Tupelo, MS 38803-3780
Phone (318) 841-9526

Other identifiers 1

IdentifierTypeStateIssuer
2470825MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20180601001952 LA Practitioner - Pathology 9830454453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Louisiana State University School of Medicine in New Orleans, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Delta Pathology Group LLCGroup PAC ID 4789639089, 28 clinicians

Practice addresses (Care Compare)

95 Judge Tanner Blvd
Covington, LA 70433-7500
Phone (985) 867-4046

Merit-based Incentive Payment System (MIPS)

Final score
71.66 of 100Reported as group
Quality
66.66
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
308024LAMDAnatomic Pathology & Clinical Pathology Physician
566797TXMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Delta Pathology Group LLC Anatomic Pathology & Clinical Pathology Current Accepting new patients
The Delta Pathology Group LLC Anatomic Pathology & Clinical Pathology CurrentSince Jul 1, 2018 Accepting new patients
The Delta Pathology Group, L.L.C. Past Accepting new patients

Locations

95 Judge Tanner Blvd
Covington, LA 70433
Phone (504) 867-3800

2915 Missouri Ave
Shreveport, LA 71109
Phone (318) 364-2000

3290 Knight St
Shreveport, LA 71105
Phone (318) 621-8820

Organizations & group practices 3

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": "1336348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530576000000",
    "number": "1598024986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3780",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388033780",
            "telephone_number": "318-841-9526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 JUDGE TANNER BLVD",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704337500",
            "telephone_number": "985-867-4046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JORDAN",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-07",
        "last_updated": "2018-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "566797",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "LA",
            "license": "308024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2470825",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

Verify at the official NPI Registry.