Individual provider Active NPI

Adam Roberts, PA-C

  • Physician Assistant
  • Prescott, AZ
National Provider Identifier
1841541505
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5279 Issued in AZ
Practice address
1947 Commerce Center Cir Ste a
Prescott, AZ 86301-4500
Phone
(928) 458-5723
Fax
(928) 237-1787
NPI assigned
Sep 20, 2012
Last updated
Jun 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5279 AZ Primary

Addresses

Primary practice location

1947 Commerce Center Cir Ste a
Prescott, AZ 86301-4500

Mailing address

1947 Commerce Center Cir Ste a
Prescott, AZ 86301-4500
Phone (928) 458-5723

Other practice location 1

3108 Clearwater Dr
Prescott, AZ 86305-7170
Phone (928) 717-8838

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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 1

Enrollment IDStateProvider typePAC IDDetails
I20130123000253 AZ Practitioner - Physician Assistant 2567615693 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prescott Complete Care, PLLCGroup PAC ID 3476982224, 5 clinicians

Practice addresses (Care Compare)

1947 Commerce Ctr Cir
Suite a
Prescott, AZ 86301-4500
Phone (928) 458-5723

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5279AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Allergy & Immunology Specialists, LLC PastSince Jun 9, 2024 Accepting new patients
Kenneth G. Lawlor, DO, PLLC Past Accepting new patients

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1348099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1841541505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1947 COMMERCE CENTER CIR STE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863014500",
            "telephone_number": "928-458-5723",
            "fax_number": "928-237-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1947 COMMERCE CENTER CIR STE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863014500",
            "telephone_number": "928-458-5723",
            "fax_number": "928-237-1787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3108 Clearwater Dr",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "AZ",
            "postal_code": "863057170",
            "country_code": "US",
            "telephone_number": "928-717-8838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "ADAM",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-20",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.