DR. KENNETH DILLON ROBERTSON PH.D.
NPI 1609070069
Psychologist in St Augustine, FL

Active since June 12, 2007PECOS EnrolledAccepts Medicare Assignment
3604 FORT PEYTON CIR, ST AUGUSTINE, FL 32086(904) 540-5310 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Kenneth Dillon Robertson Ph.d. NPPES

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

DR. KENNETH DILLON ROBERTSON PH.D. (NPI 1609070069) is an individual psychologist in St Augustine, Florida, licensed in Florida (PY 6760) and active in the NPI registry since June 2007. He is enrolled in Medicare PECOS and is a graduate of Other (1993).

NPPES Registry Identity

NPI1609070069
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. KENNETH DILLON ROBERTSONCredential: PH.D.
Location Address3604 FORT PEYTON CIRSt Augustine, FL 32086-9101
Mailing Address3604 Fort Peyton CirSt Augustine, FL 32086-9101 · (904) 540-5310
Sole ProprietorYes
Medical School CMSOtherGraduated 1993
Enumeration DateJune 12, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1609070069 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License✔ Licensed in FL · PY 6760
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
3604 FORT PEYTON CIR, St Augustine, FL 32086

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Kenneth Dillon Robertson Ph.d. 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 ID5193811032
PECOS Enrollment IDI20071023000562
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Kenneth Robertson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Internal Medicine
2001 KINGSLEY AVE
Orange Park, FL 32073
  • Reassigned Medicare billing, Florida enrollment
  • 903 clinicians in this Medicare group
Community/Behavioral Health
6750 N ANDREWS AVE STE 200
Ft Lauderdale, FL 33309
  • Reassigned Medicare billing, Florida enrollment
  • 82 clinicians in this Medicare group

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Kenneth Robertson's NPI number?

The NPI number for Kenneth Robertson is 1609070069. It was assigned to this individual provider in the NPPES registry on June 12, 2007.

Where is Kenneth Robertson located?

Kenneth Robertson practices at 3604 Fort Peyton Cir, St Augustine, FL 32086. The listed phone number is (904) 540-5310.

What is Kenneth Robertson's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Kenneth Robertson enrolled in Medicare?

Yes. Kenneth Robertson 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.

Which organizations bill Medicare for Kenneth Robertson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Robertson reassigns Medicare benefits to 2 organizations: Inpatient Consultants Of Florida, Inc (Orange Park, FL) and Che Behavioral Health Services Of Florida, P.A. (Ft Lauderdale, FL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kenneth Robertson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kenneth Robertson accept?

Health plans from Cigna HealthCare of Florida, Inc., Cigna Healthcare, Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company) and Oscar Health Maintenance Organization of Florida and 1 other insurer list Kenneth Robertson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kenneth Robertson was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.