Kenneth Dillon Robertson, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY 6760 Issued in FL

Practice address

3604 Fort Peyton Cir
St Augustine, FL 32086-9101

Phone

(904) 540-5310

NPI assigned

Jun 12, 2007

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 FL

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

Specialty

Clinical Psychologist

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Che Behavioral Health Services of Florida, P.a.Group PAC ID 5698185775, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• Che Behavioral Health Services of Florida, P.a.

  • Community/Behavioral Health Agency
  • Ft Lauderdale, FL
  • NPI 1932721206
  Medicare reassignment Care Compare group NPD
• Inpatient Consultants of Florida, Inc

  • Internal Medicine Physician
  • Orange Park, FL
  • NPI 1396795597

  Psychologist

  Medicare reassignment NPD
• Inpatient Consultants of Florida Inc

  • Hospitalist Physician
  • Tampa, FL
  • NPI 1457511164
  NPD
• John P McDonough III

  • Psychologist
  • Tampa, FL
  • NPI 1346280161
  NPD (past)

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609070069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3604 FORT PEYTON CIR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320869101",
            "telephone_number": "904-540-5310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3604 FORT PEYTON CIR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320869101",
            "telephone_number": "904-540-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "KENNETH",
        "middle_name": "DILLON",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY 6760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert C Kelsey MD PA
• Robert W Olds MD PA
• Kevin D Roberts
• Lauren Sophia Roberts
• Samiiya Faith Roberts
• Jayla Robinson
• Kiesha Marie Robinson, BCBA
• Margaret E Robinson, OT
• Mary J Robson, LCSW
• Gabrielle Roche, RMHCI

• Psychologist in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.