Edwin D Robertson, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

24420 Issued in TX

Practice address

701 Olympic Plaza Cir
Tyler, TX 75701-1950

Phone

(903) 596-3000

Fax

(903) 596-3006

NPI assigned

Jul 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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 and National Provider Directory roles.

• Etmc Physician Group Inc.

  • Cardiovascular Disease Physician
  • Tyler, TX
  • NPI 1609382662
  Medicare reassignment Care Compare group NPD
• Etmc Physician Group Inc.

  • Rural Health Clinic/Center
  • Chandler, TX
  • NPI 1235706581
  NPD
• Starks Medical

  • Primary Care Nurse Practitioner
  • Bullard, TX
  • NPI 1306570593
  NPD (past)

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

• Tyler Regional Hospital LLC

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1407364847
  Care Compare affiliation

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577750400000",
    "number": "1649200700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9477",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757119477",
            "telephone_number": "903-594-2450",
            "fax_number": "903-509-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 OLYMPIC PLAZA CIR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011950",
            "telephone_number": "903-596-3000",
            "fax_number": "903-596-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "EDWIN",
        "middle_name": "D",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "24420",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "TX",
            "license": "24420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ron L Roberts, MS
• Steven Bruce Roberts, MD
• Timothy Duane Roberts, LICENSED PROFESSIONA
• Bradley Robertson, MD
• Colvin Earl Robertson Jr., PHARM.D.
• Dolar Robinett, COTA
• Judith M Robinett, L.P.C.
• Charles Edward Robinson Jr., DDS
• Jaelee R Robinson
• Linda Robinson

• Clinical Neuropsychologist in Tyler, TX
• Providers in Tyler, TX by specialty
• Clinical Neuropsychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; 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.