Active NPI
Jonathan Robbeloth
- Foster Care Agency
- Vail, AZ
National Provider Identifier
1891192126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foster Care Agency
- Practice address
- 503 E Sterling Canyon Dr
Vail, AZ 85641-2289 - Phone
- (520) 304-9422
- NPI assigned
- Dec 2, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child Mental Illness Respite Care | 385HR2055X | 6173528 | AZ | |
| Foster Care Agency | 253J00000X | Primary |
Addresses
Primary practice location
503 E Sterling Canyon Dr
Vail, AZ 85641-2289
Mailing address
1161 N El Dorado PL Ste 103
Tucson, AZ 85715-4607
Phone (520) 748-7108
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 972921 | Medicaid | AZ |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6173528 | AZ | MD | Child Mental Illness Respite Care |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628640000000",
"number": "1891192126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1161 N EL DORADO PL STE 103",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857154607",
"telephone_number": "520-748-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "503 E STERLING CANYON DR",
"city": "VAIL",
"state": "AZ",
"postal_code": "856412289",
"telephone_number": "520-304-9422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBBELOTH",
"first_name": "JONATHAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-12-02",
"last_updated": "2021-08-11",
"certification_date": "2021-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "385HR2055X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Mental Illness, Child",
"state": "AZ",
"license": "6173528",
"primary": false
},
{
"code": "253J00000X",
"taxonomy_group": "",
"desc": "Foster Care Agency",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "972921",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vail, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.