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

Primary specialty

Family Medicine PhysicianTaxonomy code 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

Last updated

Mar 10, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

R. SHANE ROBERTS, M.D., INC.As reported in NPPES

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

Authorized official

Name

Rodney Shane Roberts, MDNPI 1306847785

Title

Owner/MD

Phone

(423) 334-2222

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

  9436060258

  Same PAC ID

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

  O20050304000259

  Same enrollment

Part of

R Shane Roberts MD Inc

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rodney Shane Roberts, MD

  • Family Medicine Physician
  • Decatur, TN
  • NPI 1306847785
  Medicare reassignment NPD Authorized official
• Michelle McCluskey, F.N.P.

  • Family Nurse Practitioner
  • Talbott, TN
  • NPI 1396756342
  Medicare reassignment NPD

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

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646870400000",
    "number": "1740936178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 709",
            "city": "DECATUR",
            "state": "TN",
            "postal_code": "373220709",
            "telephone_number": "423-334-2222",
            "fax_number": "423-334-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "398 N MAIN ST",
            "city": "DECATUR",
            "state": "TN",
            "postal_code": "373227759",
            "telephone_number": "423-334-2222",
            "fax_number": "423-334-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R. SHANE ROBERTS, M.D., INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "R. SHANE ROBERTS, M.D., INC.",
        "enumeration_date": "2022-02-24",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "423-334-2222",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Sean Morrison
• April Denise Myers, RN
• Ocoee Regional Health Corporation (Meigs County Primary Care Center)
• George F. Paul, D.D.S.
• R. Shane Roberts, M.D., Inc.
• Janet Marie Reece, F.N.P
• Restoration Clinic
• Restoration Clinic
• Restoration Clinic
• English Paige Roberts, FNP-C

• Family Medicine Physician in Decatur, TN
• Providers in Decatur, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare 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.