Individual provider Active NPI

Shelia Y Roberts, ARNP

  • Adult Health Nurse Practitioner
  • Lake City, FL
National Provider Identifier
1750358073
Registry record updated Mar 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
ARNP683592 Issued in FL
Practice address
289 SW Stonegate Ter
Suite 103
Lake City, FL 32024-3457
Phone
(386) 755-1655
Fax
(386) 755-2330
NPI assigned
Mar 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X ARNP683592 FL Primary

Addresses

Primary practice location

289 SW Stonegate Ter
Suite 103
Lake City, FL 32024-3457

Mailing address

PO Box 1642
Lake City, FL 32056-1642
Phone (386) 755-1655

Other identifiers 3

IdentifierTypeStateIssuer
PTAN E6480VOtherFLLINKED TO GROUP PTAN IE881A EFFECTIVE 07/01/15
303991900MedicaidFL
K9539OtherFLMEDICARE GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050216000805 FL Practitioner - Nurse Practitioner 9335191485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake City Cancer Care LLCGroup PAC ID 7315250685, 8 clinicians

Practice addresses (Care Compare)

289 SW Stonegate Ter
Suite 103
Lake City, FL 32024-3457
Phone (386) 755-1655

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lake City Cancer Care LLC CurrentSince Jul 1, 2015 Accepting new patients
Bruce I Timins MD PA Past Accepting new patients

Locations

4520 W US Highway 90
Lake City, FL 32055
Phone (386) 755-0601

289 SW Stonegate Ter
Ste 103
Lake City, FL 32024
Phone (386) 755-1655

104 Woodmont Blvd
Ste 500
Nashville, TN 37205
Phone (615) 467-7400

Interoperability endpoints

  • Direct secure messaging: shelia.roberts@ccofnf.ikm.direct-ci.com

Organizations & group practices 2

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 1

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": "1141603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457481600000",
    "number": "1750358073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1642",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320561642",
            "telephone_number": "386-755-1655",
            "fax_number": "386-755-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 SW STONEGATE TER",
            "address_2": "SUITE 103",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320243457",
            "telephone_number": "386-755-1655",
            "fax_number": "386-755-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "SHELIA",
        "middle_name": "Y",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-06",
        "last_updated": "2016-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "ARNP683592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LINKED TO GROUP PTAN IE881A EFFECTIVE 07/01/15",
            "identifier": "PTAN E6480V",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "303991900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "K9539",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, FL

Sources for this page

Verify at the official NPI Registry.