Individual provider Active NPI

Brandon Scott Roberts, D.O.

  • Internal Medicine Physician
  • Queen Creek, AZ
National Provider Identifier
1972864775
Registry record updated Jul 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
006701 Issued in AZ
Practice address
21772 S Ellsworth Loop Rd
Queen Creek, AZ 85142-7709
Phone
(480) 512-3700
NPI assigned
Jun 7, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 006701 AZ Primary

Addresses

Primary practice location

21772 S Ellsworth Loop Rd
Queen Creek, AZ 85142-7709

Mailing address

21772 S Ellsworth Loop Rd
Queen Creek, AZ 85142-7709
Phone (480) 512-3700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150821013349 AZ Practitioner - Internal Medicine 2668799669 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Kansas City University of Physicians and Surgeons, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Banner Primary Care Physicians Arizona LLCGroup PAC ID 6406020155, 236 clinicians

Practice addresses (Care Compare)

21772 S Ellsworth Loop Rd
Queen Creek, AZ 85142-7709
Phone (480) 512-3700

Hospital & facility affiliations

  • Banner Home Care-Arizona Home health agency, Mesa, AZ, CCN 037015
  • Banner Ironwood Medical Center Hospital, Queen Creek, AZ, CCN 030130
  • Banner Baywood Medical Center Hospital, Mesa, AZ, CCN 030088
  • Banner Gateway Medical Center Hospital, Gilbert, AZ, CCN 030122

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
006701AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Hospital Based Physicians Arizona LLC Current Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Apr 1, 2020 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Apr 1, 2020 Accepting new patients
Banner Primary Care Physicians Arizona LLC Current Accepting new patients
Banner Primary Care Physicians Arizona LLC CurrentSince Mar 1, 2020 Accepting new patients
Banner Primary Care Physicians Arizona LLC CurrentSince Mar 1, 2020 Accepting new patients

Locations

2050 W Southern Ave
Apache Junction, AZ 85120
Phone (480) 237-3200

1811 E McMurray Blvd
Casa Grande, AZ 85122
Phone (520) 374-2090

17900 N Porter Rd
Maricopa, AZ 85138
Phone (520) 233-2500

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

6644 E Baywood Ave
Mesa, AZ 85206
Phone (480) 321-2000

6750 E Baywood Ave
Mesa, AZ 85206
Phone (480) 854-5000

13640 N Plaza del Rio Blvd
Peoria, AZ 85381
Phone (623) 876-3800

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

21772 S Ellsworth Loop Rd
Queen Creek, AZ 85142
Phone (480) 512-3700

37000 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 394-4000

Organizations & group practices 6

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 4

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": "1339027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436140800000",
    "number": "1972864775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21772 S ELLSWORTH LOOP RD",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851427709",
            "telephone_number": "480-512-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21772 S ELLSWORTH LOOP RD",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851427709",
            "telephone_number": "480-512-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "BRANDON",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-07",
        "last_updated": "2015-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "006701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Queen Creek, AZ

Sources for this page

Verify at the official NPI Registry.