Randall S Roberts

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Practice address

52 Gardner Street
Apt a
Patten, ME 04765

Phone

(207) 538-5279

NPI assigned

May 6, 2009

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1241568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241568000000",
    "number": "1649404609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 226",
            "city": "PATTEN",
            "state": "ME",
            "postal_code": "047650226",
            "telephone_number": "207-538-5279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 GARDNER STREET",
            "address_2": "APT A",
            "city": "PATTEN",
            "state": "ME",
            "postal_code": "04765",
            "telephone_number": "207-538-5279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "RANDALL",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-06",
        "last_updated": "2009-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432861500",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Possessky, LCSW
• Danica L Pray, MA
• Cynthia Qualey, RDH
• Lacey E Qualey, R.N.
• Emilie N Raistrick, LCSW
• Kimberly Iverne Rodriguez, CRMA
• Rose M Fuchs
• Windy M Scott, CNA
• Kellie L Shuck, PMHNP-CNS, BC
• Kimberli Skinner, M.A.

• All providers in Patten, ME
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.