Physician Compare National (NPI:1508869926)

HEALTHCARE PROVIDER: DOUGLAS E. ROBERTS JR. M.D.

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

Individual Professional Information
NPI	1508869926
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537231261
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080711000385
	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	DOUGLAS
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PERELMAN SCHOOL OF MED AT THE UNIVERSITY OF PENNSYLVANIA
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	DOUGLAS E ROBERTS JR MD A PROFESSIONAL CORPORATION
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	8921154592
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	900 N HERITAGE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE E
	Group Practice or individual's line 2 address
City	RIDGECREST
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	935555537
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7604464571
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	051333
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	RIDGECREST REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y