Edwin D Robertson, PHD is a medicare enrolled "Clinical Neuropsychologist" provider in Tyler, Texas. He graduated from medical school in 1990 and has 35 years of diverse experience with area of expertise as Clinical Psychologist. He is a member of the group practice Etmc Physician Group, Inc. and his current practice location is
701 Olympic Plaza Cir, Tyler, Texas. You can reach out to his office (for appointments etc.) via phone at
(903) 596-3000.
Edwin D Robertson is licensed to practice in Texas (license number 24420) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1649200700.
Healthcare Provider's Profile
| Full Name | Edwin D Robertson |
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| Gender | Male |
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| Speciality | Clinical Psychologist |
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| Experience | 35 Years |
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| Location | 701 Olympic Plaza Cir, Tyler, Texas |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Edwin D Robertson graduated from medical school in 1990
NPI Data:
- NPI Number: 1649200700
- Provider Enumeration Date: 07/04/2006
- Last Update Date: 12/31/2019
Medicare PECOS Information:
- PECOS PAC ID: 9537057740
- Enrollment ID: I20040309000857
Medical Identifiers
Medical identifiers for Edwin D Robertson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1649200700 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 103T00000X | Psychologist | 24420 (Texas) | Secondary |
| 103G00000X | Clinical Neuropsychologist | 24420 (Texas) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Etmc Physician Group, Inc. | 4486915600 | 278 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Edwin D Robertson allows following entities to bill medicare on his behalf.
| Entity Name | East Texas Medical Center Healthcare Associates |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1124062484
PECOS PAC ID: 3678486222
Enrollment ID: O20031114000152 |
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| Entity Name | Etmc Physician Group, Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1609382662
PECOS PAC ID: 4486915600
Enrollment ID: O20180305002106 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Edwin D Robertson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Edwin D Robertson, PHD
Po Box 9477,
Tyler, TX 75711-9477
Ph: (903) 594-2450 | Edwin D Robertson, PHD
701 Olympic Plaza Cir,
Tyler, TX 75701-1950
Ph: (903) 596-3000 |
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