NPIMap

Individual provider Active NPI

Jacob Wesley Roberts, PA-C

  • Physician Assistant
  • Johnstown, PA
National Provider Identifier
1750861779
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA061665 Issued in PA
Practice address
411 Theatre Dr
Johnstown, PA 15904-2838
Phone
(814) 266-3934
NPI assigned
Aug 20, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C5-0001235 DE
Physician Assistant 363A00000X MA061665 PA Primary

Addresses

Primary practice location

411 Theatre Dr
Johnstown, PA 15904-2838

Mailing address

411 Theatre Dr
Johnstown, PA 15904-2838
Phone (814) 266-3934

Other practice location 1

200 Banning St
Dover, DE 19904-3485
Phone (302) 734-1414

Other practice location 2

300 E Plank Rd
Altoona, PA 16602-4154
Phone (814) 946-3801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20201023000191 PA Practitioner - Physician Assistant 7719210038 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
79.88 of 100Reported as group
Quality
62.63
Promoting interoperability
100
Improvement activities
40
Cost
70.3

Merit-based Incentive Payment System (MIPS)

Final score
80.94 of 100Reported as group
Quality
61.89
Promoting interoperability
100
Improvement activities
40
Cost
74.58

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medexpress Urgent Care, PC - Pennsylvania CurrentSince Apr 1, 2024 Accepting new patients
Somerset Health Services, Inc. CurrentSince Sep 23, 2020 Accepting new patients
Somerset Health Services, Inc. CurrentSince Sep 23, 2020 Accepting new patients
Urgent Care, PC - Pennsylvania CurrentSince Apr 1, 2024 Accepting new patients
University of Pittsburgh Physicians CurrentSince Feb 1, 2024 Accepting new patients
University of Pittsburgh Physicians CurrentSince Feb 1, 2024 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients

Locations

300 E Plank Rd
Altoona, PA 16602
Phone (814) 941-7708

426 Main St
Berlin, PA 15530
Phone (814) 267-4603

4808 Edgmont Ave
Brookhaven, PA 19015
Phone (610) 876-3072

348 Budfield St
Johnstown, PA 15904
Phone (814) 262-3950

7219 McKnight Rd
Ste F
Pittsburgh, PA 15237
Phone (412) 367-3278

3471 5th Ave
Ste 810
Pittsburgh, PA 15213
Phone (412) 692-4607

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1750861779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 THEATRE DR",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159042838",
            "telephone_number": "814-266-3934",
            "fax_number": "814-266-3934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 THEATRE DR",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159042838",
            "telephone_number": "814-266-3934"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Banning St",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "DE",
            "postal_code": "199043485",
            "country_code": "US",
            "telephone_number": "302-734-1414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 E Plank Rd",
            "address_purpose": "LOCATION",
            "city": "Altoona",
            "state": "PA",
            "postal_code": "166024154",
            "country_code": "US",
            "telephone_number": "814-946-3801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JACOB",
        "middle_name": "WESLEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-20",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0001235",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA061665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, PA

Sources for this page

Verify at the official NPI Registry.