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ETHAN ROBERTS
NPI 1497193585
Student in an Organized Health Care Education/Training Program in El Cerrito, CA

Active since June 11, 2013PECOS EnrolledAccepts Medicare Assignment
722 NORVELL ST, EL CERRITO, CA 94530(510) 647-9836 Get Directions Write a Review

NPPES record last updated: February 11, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ethan Roberts NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHAN ROBERTS (NPI 1497193585) is an individual student in an organized health care education/training program in El Cerrito, California and active in the NPI registry since June 2013. He is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1497193585
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameETHAN ROBERTS
Location Address722 NORVELL STEl Cerrito, CA 94530-3246
Mailing Address722 Norvell StEl Cerrito, CA 94530-3246 · (510) 647-9836
Phone(510) 647-9836
Sole ProprietorYes
Medical School CMSOtherGraduated 2017
Enumeration DateJune 11, 2013
Last NPPES UpdateFebruary 11, 2022
✔ NPI 1497193585 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
722 NORVELL ST, El Cerrito, CA 94530
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ethan Roberts is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5294132114
PECOS Enrollment IDI20210920003155
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Roberts's NPI number?

The NPI number for Ethan Roberts is 1497193585. It was assigned to this individual provider in the NPPES registry on June 11, 2013.

Where is Ethan Roberts located?

Ethan Roberts practices at 722 Norvell St, El Cerrito, CA 94530. The listed phone number is (510) 647-9836.

What is Ethan Roberts's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Ethan Roberts enrolled in Medicare?

Yes. Ethan Roberts is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Ethan Roberts was last updated on February 11, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.