JOHN R ROBERTS, MD - NPI NUMBER 1962441915

Summary

Provider Name: JOHN R ROBERTS, MD

NPI Number: 1962441915

Clasification: Family Medicine (207Q00000X)

Organization: FRANCISCAN PHYSICIAN NETWORK

Address:
308 W MARKET ST
CRAWFORDSVILLE, IN
ZIP 47933

Phone Number: (765) 362-5789



Detailed Information

John R Roberts, MD is a family physician in Crawfordsville, IN with 28 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. The assigned NPI number for this provider is 1962441915 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: INDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduation Year: 1987

The provider's business address is:

308 W MARKET ST
CRAWFORDSVILLE, IN
ZIP 47933
Phone: (765) 362-5789
Fax: (765) 362-2453

The enumeration date for this NPI number is 6/5/2006 and was last updated on 6/13/2014.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207Q00000X Family Medicine 01036855 IN Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 168870 MEDICARE ID-TYPE UNSPECIFIED
2 M400075750 OTHER IN MEDICARE PROVIDER PTAN
3 E06490 MEDICARE UPIN
4 100324060 MEDICAID IN

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1962441915 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name ROBERTS The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name JOHN The first name of the provider, if the provider is an individual.
5 Provider Middle Name R The middle name of the provider, if the provider is an individual.
6 Provider Credential Text MD The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
7 Provider First Line Business Practice Location Address 308 W MARKET ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name CRAWFORDSVILLE The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name IN The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 47933 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 7653625789 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 7653622453 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 6/5/2006 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 6/13/2014 The date that a record was last updated or changed.
16 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
17 Healthcare Provider Taxonomy Code 1 207Q00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
18 Provider License Number 1 01036855 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
19 Provider License Number State Code 1 IN The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Other Provider Identifier 1 168870 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
22 Other Provider Identifier Type Code 1 04 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier 2 M400075750 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 2 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier State 2 IN
26 Other Provider Identifier Issuer 2 MEDICARE PROVIDER PTAN
27 Other Provider Identifier 3 E06490 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 3 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier 4 100324060 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 4 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier State 4 IN
32 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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