NPIMap

Individual provider Active NPI

Carson Roberts, DO

  • Family Medicine Physician
  • Angola, IN
National Provider Identifier
1902420789
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11021038A Issued in IN
Practice address
306 E Maumee St Ste 201
Angola, IN 46703-2035
Phone
(260) 667-2700
Fax
(260) 667-2611
NPI assigned
Jun 8, 2020
Last updated
Aug 30, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11021038A IN Primary
General Practice Physician 208D00000X 02006478A IN

Addresses

Primary practice location

306 E Maumee St Ste 201
Angola, IN 46703-2035

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address croberts287106@Direct.Parkviewexchange.com
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230810003839 IN Practitioner - Family Practice 3072936509 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Parkview Health System IncGroup PAC ID 2163336967, 1,350 clinicians

Practice addresses (Care Compare)

306 E Maumee St
201 PPG Family Medicine
Angola, IN 46703-2035
Phone (260) 667-2700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.53 of 100Reported as group
Quality
70
Promoting interoperability
100
Improvement activities
40
Cost
75.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Health System Inc Family Medicine CurrentSince Aug 9, 2023 Accepting new patients

Locations

817 Trail Ridge Rd
Albion, IN 46701
Phone (260) 373-9590

306 E Maumee St
Ste 201
Angola, IN 46703
Phone (260) 665-8481

11109 Parkview Plaza Dr
#117
Fort Wayne, IN 46845
Phone (260) 266-6012

Interoperability endpoints

  • Direct secure messaging: croberts287106@direct.parkviewexchange.com

Organizations & group practices 1

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 11

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": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1902420789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 E MAUMEE ST STE 201",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467032035",
            "telephone_number": "260-667-2700",
            "fax_number": "260-667-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "CARSON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-08",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11021038A",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "02006478A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "croberts287106@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "306 E Maumee St Ste 201",
            "city": "Angola",
            "state": "IN",
            "country_code": "US",
            "postal_code": "467032035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "306 E Maumee St Ste 201",
            "city": "Angola",
            "state": "IN",
            "country_code": "US",
            "postal_code": "467032035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "306 E Maumee St Ste 201",
            "city": "Angola",
            "state": "IN",
            "country_code": "US",
            "postal_code": "467032035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Angola, IN

Sources for this page

Verify at the official NPI Registry.