Jared Robertson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD3699 Issued in NM

Practice address

10000 Coors Byp NW
Suite G218
Albuquerque, NM 87114-4040

Phone

(505) 242-4867

Fax

(505) 890-2883

NPI assigned

Jul 12, 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 NM

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Cottonwood Mall Dental Practice, LLC

  • Dental Clinic/Center
  • Albuquerque, NM
  • NPI 1043487119
  NPD (past)

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

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342051200000",
    "number": "1942565270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 COORS BYP NW",
            "address_2": "SUITE G218",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871144040",
            "telephone_number": "505-242-4867",
            "fax_number": "505-890-2883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 COORS BYP NW",
            "address_2": "SUITE G218",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871144040",
            "telephone_number": "505-242-4867",
            "fax_number": "505-890-2883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "JARED",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-12",
        "last_updated": "2012-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD3699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DENTAL LISENCE",
            "identifier": "DD3699",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Roberts, M.D.
• Veronica Roberts
• Cheryl Ann Robertson, NP
• Donna M Robertson, RN
• Gail Ann Robertson, MA, CPRP, LMHC
• Jennifer Robertson, CPSW
• Joshua Robertson
• Keith Robertson
• Lisa Robertson
• Nicole Deann Robertson, CNP

• General Practice Dentistry in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.