Gary Roberts Jr.

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

6202 S Lewis Ave Ste H
Tulsa, OK 74136-1064

Phone

(918) 428-8594

NPI assigned

Aug 16, 2012

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 1

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Rise Therapeutic Services, LLC

  • Counselor
  • Tulsa, OK
  • NPI 1497474423
  NPD Authorized official

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345075200000",
    "number": "1861740250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 S LOUISVILLE AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741123921",
            "telephone_number": "918-428-8594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6202 S LEWIS AVE STE H",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741361064",
            "telephone_number": "918-428-8594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "GARY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200287120A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clarence Alvin Roberts Jr., D.PH
• Clinton Kamanao'Lana Roberts, CRNA
• Corey Lee Roberts
• Elizabeth Erin Roberts, LCSW
• Faris Roberts
• Hanna J Roberts, MS, CCC-SLP
• Heather Nicole Roberts, PA-C
• James Russell Roberts
• Jarrod Roberts
• Jennifer Roberts, PHARMD

• Counselor in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.