Jennifer Roberts, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12010690A Issued in IN

Practice address

1605 N Ironwood Dr
South Bend, IN 46635-1843

Phone

(574) 271-9693

Fax

(574) 271-9719

NPI assigned

Apr 17, 2007

Sex

Female

Sole proprietor

No

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 IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Lifetime Dental Careof Indiana, PC

  • General Practice Dentistry
  • South Bend, IN
  • NPI 1891917282
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427846400000",
    "number": "1609092170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 N IRONWOOD DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351843",
            "telephone_number": "574-271-9693",
            "fax_number": "574-271-9719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 N IRONWOOD DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351843",
            "telephone_number": "574-271-9693",
            "fax_number": "574-271-9719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2015-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010690A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon L Roach, NP
• Road Runner Inc.
• Linnea M Robbins-Winters, O.D.
• Lafo Robbins, MA
• Tamika Robbins
• Lonnie D Roberts
• Tabatha Lynn Roberts, LMHC
• Robertson Family Dental
• Cydney Robinson, RBT
• Jadan Robinson

• All providers in South Bend, IN
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.