Active NPI
David Eugene Roberts, MD
- Family Medicine Physician
- Jackson, TN
National Provider Identifier
1831167295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 10295
- Practice address
- 294 Summar Dr
Jackson, TN 38301-3915 - Phone
- (731) 423-1932
- Fax
- (731) 423-4919
- NPI assigned
- Mar 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 10295 | TN | Primary |
Addresses
Primary practice location
294 Summar Dr
Jackson, TN 38301-3915
Mailing address
294 Summar Dr
Dept 289
Jackson, TN 38301-3915
Phone (731) 265-8220
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9240 | Other | TN | TLC |
| 3178084 | Medicaid | TN | |
| 3031752 | Other | TN | BLUE CROSS BLUE SHIELD TN |
| 7814407 | Other | TN | CIGNA |
| 118312 | Other | TN | BETTER HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184198400000",
"number": "1831167295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "294 SUMMAR DR",
"address_2": "DEPT 289",
"city": "JACKSON",
"state": "TN",
"postal_code": "383013915",
"telephone_number": "731-265-8220",
"fax_number": "731-265-8355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "294 SUMMAR DR",
"city": "JACKSON",
"state": "TN",
"postal_code": "383013915",
"telephone_number": "731-423-1932",
"fax_number": "731-423-4919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "DAVID",
"middle_name": "EUGENE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-10",
"last_updated": "2007-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TN",
"license": "10295",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TLC",
"identifier": "9240",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3178084",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD TN",
"identifier": "3031752",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "7814407",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BETTER HEALTH",
"identifier": "118312",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.