JASON ROBERTS (NP) – Family Nurse Practitioner, NPI 1003269895

Family Nurse Practitioner

JASON ROBERTS (NP) is a healthcare provider. based in Rockford, Michigan. specializing in NURSE PRACTITIONER. They hold the professional credentials NP. They hold a License No. 4704219864 (MI). The NPI Number for JASON ROBERTS (NP) is 1003269895

Main info

Male

10 Years Of Experience

Accepts Medicare Assignment

Name

JASON ROBERTS (NP)

NPI

1003269895

Phone

(313) 918-9340

Address

199 LONGVIEW DR

Enumeration Date

18 July 2016

Last Update Date

23 April 2026

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2488246060

Graduation Year

2016 (10 years ago)

PAC ID

8224324066

Group Practice PAC ID

9234041948

Professional Enrollment ID

I20160906000221

Address ID

MI48084XXXXTRXXXXXXXXXX00

Telehealth

Yes

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience52

Completeness85

Years active:9State licenses:1Digital endpointsOther names

8,106 NURSE PRACTITIONER in MI

Provider Addresses for JASON ROBERTS (NP)

Longview Drive, Rockford, Kent County, Michigan, 49351, United States
ROCKFORD, MI 493411130
Phone: (313) 918-9340
Type: Mailing
15146 16th Ave
Marne, MI 494359605
Phone: (844) 776-9651
Type: Location
PO BOX 40412
BELFAST, ME 049151255
Phone: (248) 824-6600
Type: Mailing
500 KIRTS BLVD STE 200
TROY, MI 480844140
Phone: (248) 824-6500
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2016-09-06

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

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
I20160906000221	I	Nurse Practitioner	MI	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.

Verify on CMS Revalidation Lookup Tool

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 49341)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9234041948View full group profile

Name	Specialty	State
DR. DEREK WILLIAMSON SHERK (MD)	-	OH
DIANNE JUNIOR (NP)	-	MI
DR. MOSTAFA MIRHAIDARI (D.O.)	-	OH
MICHAEL D HAZELBERG (DO)	-	WI
JENNIFER SHAWN EDGAR (APRN, BC)	Nurse Practitioner	KY
SALMAN RAHMAN (M.D.)	Internal Medicine	MI
VARINIA URDAY-GAMALSKI (M.D.)	Internal Medicine	MI
HASHIM SADIG (M.D.)	Internal Medicine	WI
Unknown Individual	-	VA
MARK F GILLETTE (PA-C)	-	MI