Marilyn Nichole Moulton Roberts, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1404 Issued in AL

Practice address

1210 Brookstone Centre Pkwy
Columbus, GA 31904-9272

Phone

(706) 322-1717

Fax

(706) 322-1718

NPI assigned

Oct 22, 2018

Sex

Female

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 AL, GA2 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

University of South Alabama College of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lane Dermatology and Dermatologic Surgery LLCGroup PAC ID 7719072941, 7 clinicians

Lane Dermatology, LLCGroup PAC ID 2163966383, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

82.42 of 100Reported as group

Quality

82.18

Improvement activities

40

Cost

65.18

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Lane Dermatology & Dermatologic Surgery LLC

  • MOHS-Micrographic Surgery Physician
  • Columbus, GA
  • NPI 1437363587
  Medicare reassignment Care Compare group
• Lane Dermatology, LLC

  • Dermatology Physician
  • Auburn, AL
  • NPI 1538919758
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1540166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1811463490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 BROOKSTONE CENTRE PKWY",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319049272",
            "telephone_number": "706-322-1717",
            "fax_number": "706-322-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 BROOKSTONE CENTRE PKWY",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319049272",
            "telephone_number": "706-322-1717",
            "fax_number": "706-322-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MARILYN",
        "middle_name": "NICHOLE MOULTON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-22",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "1404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evelyn Nicole Roberts, LCSW
• Frederick T Roberts, MD
• James Roberts V, MLT
• Kathleen Roberts, M.D.
• Kristin Roberts, LPC
• Rene Welch Roberts, D.M.D.
• Anastasia Robertson
• Katrina L Robertson, RBT
• Stephanie Erin Robertson, NP
• Ludmilla Oresha Robinson Pollard

• Physician Assistant in Columbus, GA
• Providers in Columbus, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; 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.