NPIMap

Individual provider Active NPI

Stacey S Roberts, MD

  • Gastroenterology Physician
  • Clive, IA
National Provider Identifier
1912965146
Registry record updated May 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
34960 Issued in IA
Practice address
1378 NW 124TH St
Suite 200
Clive, IA 50325-8151
Phone
(515) 288-6097
Fax
(515) 288-6099
NPI assigned
May 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 34960 IA Primary

Addresses

Primary practice location

1378 NW 124TH St
Suite 200
Clive, IA 50325-8151

Mailing address

1378 NW 124TH St
Suite 200
Clive, IA 50325-8151
Phone (515) 288-6097

Other identifiers 1

IdentifierTypeStateIssuer
0293779MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20060417000074 IA Practitioner - GastroenterologyPractitioner - Internal Medicine 5698782183 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Iowa, RJ & L Carver College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iowa Digestive Disease Center PCGroup PAC ID 4183522188, 24 clinicians

Practice addresses (Care Compare)

1378 NW 124TH St
Clive, IA 50325-8151

1660 60TH St
West Des Moines, IA 50266-7700
Phone (515) 263-5770

3625 N Ankeny Blvd
Suite D
Ankeny, IA 50023-4611
Phone (515) 288-6097

Hospital & facility affiliations

  • Unitypoint Health - Des Moines Iowa Methodist Medi Hospital, Des Moines, IA, CCN 160082
  • Mercyone Des Moines Medical Center Hospital, Des Moines, IA, CCN 160083

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy144
Upper gastrointestinal (GI) endoscopy for acid reflux112

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34960IAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Digestive Disease Center P.C. Gastroenterology CurrentSince Sep 1, 2003 Accepting new patients
Iowa Endoscopy Center, Inc. PastSince Jul 1, 2014 Accepting new patients

Locations

1378 NW 124th St
Ste 200
Clive, IA 50325
Phone (515) 288-6097

1378 NW 124th St
Clive, IA 50325
Phone (515) 288-6097

1378 NW 124th St
Ste 100
Clive, IA 50325
Phone (515) 288-3342

Organizations & group practices 2

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.

Hospital & facility affiliations 7

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": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430870400000",
    "number": "1912965146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1378 NW 124TH ST",
            "address_2": "SUITE 200",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258151",
            "telephone_number": "515-288-6097",
            "fax_number": "515-288-6099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1378 NW 124TH ST",
            "address_2": "SUITE 200",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258151",
            "telephone_number": "515-288-6097",
            "fax_number": "515-288-6099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "STACEY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2015-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IA",
            "license": "34960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0293779",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clive, IA

Sources for this page

Verify at the official NPI Registry.