Individual provider Active NPI

Jessica L Roberts, DO

  • Obstetrics & Gynecology Physician
  • Raton, NM
National Provider Identifier
1821078270
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
A-1336-05 Issued in NM
Practice address
203 Hospital Dr
Raton, NM 87740-2012
Phone
(575) 445-3661
NPI assigned
Jan 20, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X A-1336-05 NM Primary

Addresses

Primary practice location

203 Hospital Dr
Raton, NM 87740-2012

Mailing address

203 Hospital Dr Ste 180
Raton, NM 87740-2012
Phone (575) 445-3661

Other identifiers 1

IdentifierTypeStateIssuer
75731827MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051025000281 NM Practitioner - Obstetrics/Gynecology 0446285175 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
85.56 of 100Reported as group
Quality
71.49
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Miners Colfax Medical Center Current Accepting new patients
San Miguel Clinic Corp CurrentSince Dec 15, 2019 Accepting new patients
Miners Colfax Medical Center CurrentSince Jul 11, 2015 Accepting new patients
Taos Health Systems, Inc., Holy Cross Hospital Past Accepting new patients

Locations

105 Mills Ave
Ste 100
Las Vegas, NM 87701
Phone (505) 425-3313

108 Legion Dr
Ste D
Las Vegas, NM 87701
Phone (505) 425-3569

203 Hospital Dr
Raton, NM 87740
Phone (505) 445-2741

203 Hospital Dr
Ste 180
Raton, NM 87740

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/1762c86e-d105-4afc-a3d1-9e89748c9af3/

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1821078270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 HOSPITAL DR STE 180",
            "city": "RATON",
            "state": "NM",
            "postal_code": "877402012",
            "telephone_number": "575-445-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 HOSPITAL DR",
            "city": "RATON",
            "state": "NM",
            "postal_code": "877402012",
            "telephone_number": "575-445-3661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JESSICA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NM",
            "license": "A-1336-05",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "75731827",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raton, NM

Sources for this page

Verify at the official NPI Registry.