R. Shane Roberts, M.D., Inc.

Key facts

NPI: 1740936178
Entity type: Organization (NPI type 2)
Primary specialty: Family Medicine Physician 207Q00000X
Legal business name: R. SHANE ROBERTS, M.D., INC.
Practice address: 398 N Main St
Decatur, TN 37322-7759
Phone: (423) 334-2222
Fax: (423) 334-2255
NPI assigned: Feb 24, 2022
Organization subpart: Yes
Parent organization (as reported): R. SHANE ROBERTS, M.D., INC.

Authorized official

Name: Rodney Shane Roberts, MD NPI 1306847785
Title: Owner/MD
Phone: (423) 334-2222

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

R. Shane Roberts, M.D., Inc. Family Medicine Physician · Decatur, TN · NPI 1508062977

NPPES parent name

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

R. Shane Roberts, M.D., Inc. Family Medicine Physician · Decatur, TN · NPI 1508062977

Same enrollment O20050304000259

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

R. Shane Roberts, M.D., Inc. Family Medicine Physician · Decatur, TN · NPI 1508062977

Same PAC ID 9436060258

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Rodney Shane Roberts, MD Family Medicine Physician · Decatur, TN · NPI 1306847785

Medicare reassignment NPD Authorized official FAMILY MEDICINE · TN
Michelle McCluskey, F.N.P. Family Nurse Practitioner · Talbott, TN · NPI 1396756342

Medicare reassignment NPD TN

Medicare participation

Medicare fee-for-service enrollment: Enrolled in TN

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20050304000259	TN	Part B Supplier - Clinic/Group Practice	9436060258	Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment Practice locations: Decatur, TN

National Provider Directory

Part of: Shane Roberts MD

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician Group: 193400000X SINGLE SPECIALTY GROUP	207Q00000X			Yes

Addresses

Primary practice location

398 N Main St
Decatur, TN 37322-7759

Mailing address

PO Box 709
Decatur, TN 37322-0709
Phone (423) 334-2222

Other providers in Decatur, TN

All providers in Decatur, TN · Family Medicine Physician in Tennessee

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.