NPIMap

Individual provider Active NPI

Susan Tracy Roberts, NP-C

  • Nurse Practitioner
  • Fancy Gap, VA
National Provider Identifier
1730453283
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0024169878 Issued in VA
Practice address
1661 Turner Spur Rd
Fancy Gap, VA 24328-4365
Phone
(276) 728-0735
Fax
(276) 728-7717
NPI assigned
Mar 1, 2012
Last updated
Jul 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024169878 VA Primary
Occupational Health Nurse Practitioner 363LX0106X 5006199 NC
Adult Medicine Physician 207QA0505X 0024169878 VA

Addresses

Primary practice location

1661 Turner Spur Rd
Fancy Gap, VA 24328-4365

Mailing address

1661 Turner Spur Rd
Fancy Gap, VA 24328-4365
Phone (276) 728-0735

Other identifiers 1

IdentifierTypeStateIssuer
363L00000XOtherVATAXONOMY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20120404000002 VA Practitioner - Nurse Practitioner 4082874888 Practice locations: Fancy Gap, VA

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1661 Turner Spur Rd
Fancy Gap, VA 24328-4365
Phone (276) 728-0735

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5006199NCMDOccupational Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fancy Gap Internal Medicine Single Specialty CurrentSince Aug 4, 2024 Accepting new patients
Danville Physician Practices LLC Single Specialty Past Accepting new patients
Fancy Gap Internal Medicine Single Specialty Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19847/brand/3/csg/21/fhir/r4

Organizations & group practices 3

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.

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": "1330560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1730453283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 TURNER SPUR RD",
            "city": "FANCY GAP",
            "state": "VA",
            "postal_code": "243284365",
            "telephone_number": "276-728-0735",
            "fax_number": "276-728-7717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 TURNER SPUR RD",
            "city": "FANCY GAP",
            "state": "VA",
            "postal_code": "243284365",
            "telephone_number": "276-728-0735",
            "fax_number": "276-728-7717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "SUSAN",
        "middle_name": "TRACY",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-01",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024169878",
            "primary": true
        },
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "NC",
            "license": "5006199",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "VA",
            "license": "0024169878",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "363L00000X",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fancy Gap, VA

Sources for this page

Verify at the official NPI Registry.