Jacob Benjamin Roberts, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT - 2217 Issued in ID

Practice address

1542 Elk Creek Dr
Suite B
Idaho Falls, ID 83404-8322

Phone

(208) 521-7336

NPI assigned

Jun 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eagle Rock Physical Therapy PLLCGroup PAC ID 0941397343, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eagle Rock Physical Therapy PLLC

  • Physical Therapy Clinic/Center
  • Idaho Falls, ID
  • NPI 1174712418
  Medicare reassignment Care Compare group NPD Authorized official
• Eagle Rock Physical Therapy

  • Physical Therapy Clinic/Center
  • Idaho Falls, ID
  • NPI 1649449430
  NPD Authorized official
• Vista Healthcare PC

  • Primary Care Clinic/Center
  • Rexburg, ID
  • NPI 1720502370
  NPD (past)

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185840000000",
    "number": "1790989945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1169 WASHBURN AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834021607",
            "telephone_number": "208-521-7336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1542 ELK CREEK DR",
            "address_2": "SUITE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048322",
            "telephone_number": "208-521-7336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JACOB",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2007-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT - 2217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• RM Lab LLC
• Road Runner Shuttle, LLC
• Robert J Brock MD PA
• Robert J. Lee, M.D., PC
• Eric Deloy Roberts, MSPT
• Jane C Roberts, MS, SLP-CCC
• Jared Roberts
• John Henry Allen Roberts
• Katie Jo Roberts
• Maryia Lindsay Roberts

• Physical Therapist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.