NPIMap

Individual provider Active NPI

Randolph Roberts, MD

  • Diagnostic Radiology Physician
  • Crown Point, IN
National Provider Identifier
1659368017
Registry record updated Jan 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01036988 Issued in IN
Practice address
1201 S Main St
Crown Point, IN 46307-8481
Phone
(219) 757-6320
Fax
(219) 738-6714
NPI assigned
Sep 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 01036988 IN Primary

Addresses

Primary practice location

1201 S Main St
Crown Point, IN 46307-8481

Mailing address

55 E 86TH Ave
PO Boix 10645
Merrillville, IN 46410-6382
Phone (219) 769-1670

Other identifiers 1

IdentifierTypeStateIssuer
200005040MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050712001222 IN Practitioner - Diagnostic Radiology 9133155070 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Indiana University School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imaging Associates of Indiana PCGroup PAC ID 1254503345, 293 clinicians

Practice addresses (Care Compare)

1201 S Main St
Crown Point, IN 46307-8481
Phone (219) 757-6320

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01036988INMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Imaging Associates of Indiana, PC Diagnostic Radiology CurrentSince Sep 12, 2011 Accepting new patients
Franciscan Physician Network Past Accepting new patients
Franciscan Physician Network Past Accepting new patients
Munster Radiology Group PC Diagnostic Radiology Past Accepting new patients
Illiana Surgery & Medical Center, LLC Past Accepting new patients

Locations

1710 Lafayette Rd
Ste 104
Crawfordsville, IN 47933
Phone (765) 362-2800

1201 S Main St
Crown Point, IN 46307
Phone (219) 738-2100

24 Joliet St
Dyer, IN 46311
Phone (219) 864-2237

1701 S Creasy Ln
Lafayette, IN 47905
Phone (765) 502-4400

3500 Franciscan Way
Michigan City, IN 46360
Phone (219) 852-1524

701 Superior Ave
Munster, IN 46321
Phone (219) 922-4200

1104 E Grace St
Rensselaer, IN 47978
Phone (219) 866-2026

2411 Laporte Ave
Valparaiso, IN 46383
Phone (219) 476-7226

Interoperability endpoints

  • Direct secure messaging: rroberts65148@direct.franciscanalliance.org

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327449600000",
    "number": "1659368017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E 86TH AVE",
            "address_2": "PO BOIX 10645",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106382",
            "telephone_number": "219-769-1670",
            "fax_number": "219-738-6714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S MAIN ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078481",
            "telephone_number": "219-757-6320",
            "fax_number": "219-738-6714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "RANDOLPH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2012-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01036988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200005040",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.