Matthew C Roberts, NP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

2021022217 Issued in MO

Practice address

12101 Woodcrest Executive Dr Ste 102
Saint Louis, MO 63141-5047

Phone

(800) 427-1902

NPI assigned

Dec 7, 2021

Last updated

Dec 7, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Berwald Surgical Medical IncGroup PAC ID 0840484861, 4 clinicians

Michele Ann Roberts PCGroup PAC ID 8527162684, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health Depaul Hospital St Louis Hospital, Bridgeton, MO, CCN 260104

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Berwald Surgical Medical Inc

  dba David Berwald MD

  • Non-Pharmacy Dispensing Site
  • Bridgeton, MO
  • NPI 1548345838
  Medicare reassignment Care Compare group NPD
• Michele Ann Roberts, P C

  • Gerontology Nurse Practitioner
  • Valley Park, MO
  • NPI 1811044233
  Medicare reassignment Care Compare group NPD
• Tatyana Petrosova, MD PC

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1700026515
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• SSM Health Care St. Louis

  dba SSM Health DePaul Hospital - St. Louis

  • General Acute Care Hospital
  • Bridgeton, MO
  • NPI 1598835308
  Care Compare affiliation

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

{
    "created_epoch": "1638835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1598423543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST FL 15",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12101 WOODCREST EXECUTIVE DR STE 102",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415047",
            "telephone_number": "800-427-1902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MATTHEW",
        "middle_name": "C",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-07",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2021022217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly M Roberts, FNP-C
• Kelsey Roberts, MD
• Khadijah Akilah Roberts
• Krystina Roberts, NP
• Lisa Jane Marie Lukies Roberts, LMSW
• Maxine Roberts
• Meredith D. Roberts, M.S.
• Michelle Dawn Roberts, LPC, NCC
• Misty M Roberts, ARDMS,RVT
• Patricia Roberts, LPN

• Gerontology Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Gerontology Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; 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.