Keith Wesley Roberts, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001006432 Issued in NC

Practice address

2800 Blue Ridge Rd
Suite 400
Raleigh, NC 27607-6478

Phone

(919) 787-5380

NPI assigned

Dec 30, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC, PA2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• University of Penn - Medical Group

  • Cardiovascular Disease Physician
  • Philadelphia, PA
  • NPI 1093725145
  Medicare reassignment Care Compare group NPD
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD
• Rex Hospital Inc

  • Cardiovascular Disease Physician
  • Raleigh, NC
  • NPI 1972939643
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hospital of the University of PA

  • Ambulatory Fertility Facility
  • Phila, PA
  • NPI 1033262316

  Hospital

  Care Compare affiliation
• Trustees of the University of Pennsylvania

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1851370910
  Care Compare affiliation

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

{
    "created_epoch": "1419897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1811385776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 EDWARDS MILL RD",
            "address_2": "APARTMENT D",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276124439",
            "telephone_number": "540-915-3487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 BLUE RIDGE RD",
            "address_2": "SUITE 400",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076478",
            "telephone_number": "919-787-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KEITH",
        "middle_name": "WESLEY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-30",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00362300",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001006432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kroberts192525@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2800 Blue Ridge Rd",
            "address_2": "Suite 400",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276076478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Heather Roberts, RN
• Jane McCarthy Roberts, LCSW
• Jasmine Roberts
• Jennifer Paige Roberts, MA
• Justin L Roberts, DDS
• Lee Ann Roberts, M.D.
• Lisa Marie Roberts, M.D.
• Maria Margarita Roberts, OTRL
• Patricia G Roberts, LPC
• Rachel Allison Roberts, MSW, LCSWA

• Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.