Active NPI
Audrey M Roberts, MD
- Pediatrics Physician
- Wichita, KS
National Provider Identifier
1992732374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 22725
- Practice address
- 3311 E Murdock St
Wichita, KS 67208-3054 - Phone
- (316) 689-9107
- Fax
- (316) 689-9354
- NPI assigned
- Jun 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 22725 | KS | Primary |
Addresses
Primary practice location
3311 E Murdock St
Wichita, KS 67208-3054
Mailing address
PO Box 8035
Wichita, KS 67208-0035
Phone (316) 689-9135
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1707 | Other | KS | PHS |
| 100405 | Other | KS | HPK |
| 168637 | Other | KS | COVENTRY |
| 024978 | Other | KS | BCBS |
| 12149397 | Other | KS | MULTIPLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140115001747 | KS | Order and Referring Only - Pediatric Medicine | 4284616400 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22725 | KS | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184284800000",
"number": "1992732374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8035",
"city": "WICHITA",
"state": "KS",
"postal_code": "672080035",
"telephone_number": "316-689-9135",
"fax_number": "316-689-9102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3311 E MURDOCK ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672083054",
"telephone_number": "316-689-9107",
"fax_number": "316-689-9354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "AUDREY",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-28",
"last_updated": "2007-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "KS",
"license": "22725",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHS",
"identifier": "1707",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPK",
"identifier": "100405",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY",
"identifier": "168637",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "024978",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "12149397",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; 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.