MR. KENNETH M. ROBERTS (P.A.) – Physician Assistant, NPI 1285748954
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for MR. KENNETH M. ROBERTS (P.A.)
300, Clyde Morris Boulevard, Ormond Beach, Volusia County, Florida, 32174, United States
SUITE C
ORMOND BEACH, FL 321745956
Phone: (386) 673-5100
Fax: (386) 673-6014
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 56 Open Payments records for all available years, with a total value of $1,091.
Total Amount is formed as General ($1,091) + Research ($0) + Ownership ($0) = $1,091.
Last reported payment date: 2024-11-13 • Largest payer in this snapshot: Sumitomo Pharma America, Inc. ($255).
Total Amount
$1,091
General + Research + Ownership
Payments
56
Total payment records
General Amount
$1,091
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Sumitomo Pharma America, Inc. | $255 |
| ABBVIE INC. | $195 |
| Astellas Pharma US Inc | $185 |
| Myriad Genetic Laboratories, Inc. | $108 |
| TOLMAR, INC. | $74 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-04-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20070404000210 | I | Physician Assistant | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32174)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | FL | |
| U R O L O G Y | FL | |
| U R O L O G Y | FL | |
| Radiation Oncology, Urology | FL | |
| P A T H O L O G Y | TX | |
| Pathology, Hematology | IN | |
| U R O L O G Y | FL | |
| - | FL | |
| U R O L O G Y | OH |
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