NPIMap

Individual provider Active NPI

Kristianna K. Roberts, M.D.

  • Family Medicine Physician
  • Broomfield, CO
National Provider Identifier
1790955185
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
235959 Issued in MA
Practice address
340 E 1St Ave Ste 101
Broomfield, CO 80020-2401
Phone
(303) 544-3800
Fax
(303) 544-3810
NPI assigned
Mar 3, 2008
Last updated
Sep 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4656 AZ
Family Medicine Physician 207Q00000X DR.0051499 CO
Family Medicine Physician 207Q00000X 235959 MA Primary

Addresses

Primary practice location

340 E 1St Ave Ste 101
Broomfield, CO 80020-2401

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (970) 624-4451

Other practice location 1

1030 President Avenue
Suite 104 Southcoast Physician Services, Inc.
Fall River, MA 02720
Phone (508) 730-3100

Other practice location 2

11310 Huron St Ste 100
Northglenn, CO 80234-3090
Phone (303) 450-7435

Other identifiers 1

IdentifierTypeStateIssuer
9000159544MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20120920000172 CO Practitioner - Family Practice 1052471430 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

11310 Huron St
Suite 100
Northglenn, CO 80234-3090
Phone (303) 450-7435

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4656AZMDFamily Medicine Physician
DR.0051499COMDFamily Medicine Physician
235959MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Health Initiatives Colorado Family Medicine CurrentSince Sep 3, 2024 Accepting new patients
Catholic Health Initiatives Colorado Current Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Sep 3, 2024 Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients
Southcoast Physicians Group, Inc. Family Medicine Past Accepting new patients

Locations

9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193

11310 Huron St
Ste 100
Northglenn, CO 80234
Phone (303) 254-2664

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1204502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1790955185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-624-4451",
            "fax_number": "970-490-4199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 E 1ST AVE STE 101",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800202401",
            "telephone_number": "303-544-3800",
            "fax_number": "303-544-3810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1030 President Avenue",
            "address_2": "Suite 104 Southcoast Physician Services, Inc.",
            "address_purpose": "LOCATION",
            "city": "Fall River",
            "state": "MA",
            "postal_code": "02720",
            "country_code": "US",
            "telephone_number": "508-730-3100",
            "fax_number": "508-730-3150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11310 Huron St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Northglenn",
            "state": "CO",
            "postal_code": "802343090",
            "country_code": "US",
            "telephone_number": "303-450-7435",
            "fax_number": "303-450-7463",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KRISTIANNA",
        "middle_name": "K.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-03",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "4656",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0051499",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "235959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000159544",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomfield, CO

Sources for this page

Verify at the official NPI Registry.