Active NPI
Roberta Samelson Bracken, M.D.
- Endocrinology, Diabetes & Metabolism Physician
- Bolivia, NC
National Provider Identifier
1770557753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician
- License
- 35280
- Practice address
- 25 Courthouse Dr NE
Bolivia, NC 28422 - Phone
- (910) 253-2250
- Fax
- (910) 253-2370
- NPI assigned
- Feb 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 35280 | NC | Primary |
Addresses
Primary practice location
25 Courthouse Dr NE
Bolivia, NC 28422
Mailing address
25 Courthouse Drive NE
P O Box 9
Bolivia, NC 28422
Phone (910) 253-2250
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8917621 | Medicaid | NC | |
| 1770557753 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Goshen Medical Center Incorporated | Past | Accepting new patients |
Interoperability endpoints
- rbracken@goshenmedical.cloudcraftdirect.com
Organizations & group practices 1
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.
-
dba Goshen Medical Center - Rosewood
- Federally Qualified Health Center (FQHC)
- Goldsboro, NC
- NPI 1194128991
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652832000000",
"number": "1770557753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 COURTHOUSE DRIVE NE",
"address_2": "P O BOX 9",
"city": "BOLIVIA",
"state": "NC",
"postal_code": "28422",
"telephone_number": "910-253-2250",
"fax_number": "910-253-2370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 COURTHOUSE DR NE",
"city": "BOLIVIA",
"state": "NC",
"postal_code": "28422",
"telephone_number": "910-253-2250",
"fax_number": "910-253-2370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACKEN",
"first_name": "ROBERTA",
"middle_name": "SAMELSON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-15",
"last_updated": "2022-05-18",
"certification_date": "2022-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "NC",
"license": "35280",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8917621",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1770557753",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bolivia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.