Mallory Sanderfur Roberts, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1421DT Issued in KY

Practice address

255 Main St
Calhoun, KY 42327-2104

Phone

(270) 273-3000

Fax

(270) 273-9252

NPI assigned

Oct 3, 2006

Last updated

Jun 18, 2014By the provider in NPPES

Sex

Female

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 2

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

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 2

Specialty

Optometry

Education

University of Alabama School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bluegrass Family Eyecare Inc.Group PAC ID 3274525290, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bluegrass Family Eyecare Inc.

  • Optometrist
  • Beaver Dam, KY
  • NPI 1598838385
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403049600000",
    "number": "1679668198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 411",
            "city": "CALHOUN",
            "state": "KY",
            "postal_code": "423270411",
            "telephone_number": "270-273-3000",
            "fax_number": "270-273-9252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 MAIN ST",
            "city": "CALHOUN",
            "state": "KY",
            "postal_code": "423272104",
            "telephone_number": "270-273-3000",
            "fax_number": "270-273-9252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MALLORY",
        "middle_name": "SANDERFUR",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2014-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1421DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77903375",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77014215",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McLean County Treasurer
• Jennifer Owen, CSW
• Owensboro Health Medical Group, Inc (Owensboro Health Medical Group - Family Medicine)
• Mary Ann Rafferty
• Regional Health Care Affiliates, Inc
• James Douglas Toler, M.S.
• Rhynhardt Van Wyk
• Walgreen Co (Walgreens #17444)
• Alicia Waltrip, MPT
• Hugh Hamilton Wilhite, MD

• Optometrist in Calhoun, KY
• Providers in Calhoun, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; 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.