Jacob Edward Roberts, D.O

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

5101015635 Issued in MI

Practice address

14555 Levan Rd
Marion Professional Building Suite 311
Livonia, MI 48154-5083

Phone

(734) 655-2692

Fax

(734) 655-4218

NPI assigned

Mar 28, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

General Surgery

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Iha Olma Specialty 1 LLCGroup PAC ID 6901206689, 67 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joe Mercy Hospital System Livonia Hospital, Livonia, MI, CCN 230002
• Trinity Health Livingston Hospital Hospital, Howell, MI, CCN 230069
• Trinity Health Oakland Hospital Hospital, Pontiac, MI, CCN 230029
• Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jroberts44523@direct.trinity-health.org

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.

• Iha Olma Specialty 1 LLC

  • Obstetrics & Gynecology Physician
  • Livonia, MI
  • NPI 1891371118
  Medicare reassignment Care Compare group NPD
• St Mary Mercy Physician Practices

  • Multi-Specialty Clinic/Center
  • Livonia, MI
  • NPI 1568630077
  Medicare reassignment NPD
• Iha Health Services Corporation

  • Obstetrics & Gynecology Physician
  • Canton, MI
  • NPI 1457408965
  Medicare reassignment
• Iha Olma Specialty 1 LLC

  • Surgical Critical Care Physician
  • Livonia, MI
  • NPI 1114667144

  Surgery

  NPD
• St Mary Mercy Hospital

  • General Acute Care Hospital
  • Livonia, MI
  • NPI 1790706901
  NPD
• St Mary Mercy Physician Practices

  • Urgent Care Clinic/Center
  • Livonia, MI
  • NPI 1184154544
  NPD
• St Joseph Mercy Hospital-SMHC

  • General Acute Care Hospital
  • Pontiac, MI
  • NPI 1053356352
  NPD (past)

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

• Saint Joseph Mercy Livingston Hospital

  • General Acute Care Hospital
  • Brighton, MI
  • NPI 1093748642
  Care Compare affiliation
• St Joseph Mercy Hospital

  • General Acute Care Hospital
  • Ypsilanti, MI
  • NPI 1780658443
  Care Compare affiliation
• St Joseph Mercy Hospital-SMHC

  • General Acute Care Hospital
  • Pontiac, MI
  • NPI 1053356352
  Care Compare affiliation
• St Mary Mercy Hospital

  • General Acute Care Hospital
  • Livonia, MI
  • NPI 1790706901
  Care Compare affiliation

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254355200000",
    "number": "1831218817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7932 GOSHEN DR",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483225002",
            "telephone_number": "248-417-7730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14555 LEVAN RD",
            "address_2": "MARION PROFESSIONAL BUILDING SUITE 311",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481545083",
            "telephone_number": "734-655-2692",
            "fax_number": "734-655-4218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JACOB",
        "middle_name": "EDWARD",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2009-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101015635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM  INDIV",
            "identifier": "0256305894",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GRP",
            "identifier": "010H233560",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Graham PC
• Robert J. Rowe, PH.D., P.C.
• Robert S Ciemiega DO PC
• Brendan T Roberts, LLMSW
• Cynthia Roberts, PTA
• Kathryn Roberts
• Mary Geralyn Walsh Roberts, MD
• Trisha Roberts, CCP
• Jalisa Marna Robertson, BEHAVIOR TECHNICIAN
• Kristen Robertson, PT, DPT

• Surgery Physician in Livonia, MI
• Providers in Livonia, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; 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.