Physician Compare National (NPI:1043735509)

HEALTHCARE PROVIDER: DEREK L ROBERTS APRN-BC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1043735509
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4385906981
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180319002831
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROBERTS
	Individual professional last name
Provider First Name	DEREK
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2017
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	8100 E 22ND ST N
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1600 B
	Group Practice or individual's line 2 address
City	WICHITA
	Group Practice or individual's city
State	KS
	Group Practice or individual's state
Zip Code	672262321
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3162016424
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M