Randy Roth, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MS14779 Issued in MS

Practice address

2809 Denny Ave
Pascagoula, MS 39581-5301

Phone

(228) 809-5510

Fax

(228) 809-5519

NPI assigned

Jan 15, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

University of Alabama School of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Singing River GulfportGroup PAC ID 5294154829, 75 clinicians

Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Singing River Health System Hospital, Pascagoula, MS, CCN 250040
• Singing River Gulfport Hospital, Gulfport, MS, CCN 250123

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Singing River Health System

  • Skilled Nursing Facility
  • Pascagoula, MS
  • NPI 1548700909

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Singing River Gulfport

  • Multi-Specialty Clinic/Center
  • Gulfport, MS
  • NPI 1861010159
  Medicare reassignment Care Compare group NPD
• Singing River Health System

  • Multi-Specialty Clinic/Center
  • Gautier, MS
  • NPI 1083893937
  Medicare reassignment Care Compare group NPD
• Singing River Gulfport

  • Internal Medicine Physician
  • Gulfport, MS
  • NPI 1487327193
  NPD
• Singing River Health System

  • Internal Medicine Physician
  • Pascagoula, MS
  • NPI 1134283419
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Singing River Gulfport

  • General Acute Care Hospital
  • Gulfport, MS
  • NPI 1639797913
  Care Compare affiliation
• Singing River Health System

  • Multi-Specialty Clinic/Center
  • Gautier, MS
  • NPI 1083893937

  Hospital

  Care Compare affiliation
• Singing River Health System

  • General Acute Care Hospital
  • Pascagoula, MS
  • NPI 1124136593
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1013068212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 DENNY AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815301",
            "telephone_number": "228-809-5510",
            "fax_number": "228-809-5519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2809 DENNY AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815301",
            "telephone_number": "228-809-5510",
            "fax_number": "228-809-5519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "RANDY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "MS14779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009917145",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MS",
            "identifier": "646000515E",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "60039090",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RR00116679",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Simon Georges Rizk, M.D.
• Robert B. Burns, MD
• Timothy R Robinson, ACNP
• Amy Vanderbeck Rogers, ACNP-BC
• Ronald Rosenquist, D.O.
• Alexis Rountree, PHARMD
• Royal in Home Care LLC
• Olivia Russell
• Alicia Desiree Davion Rutledge
• S & S Pharmacy Inc

• Internal Medicine Physician in Pascagoula, MS
• Providers in Pascagoula, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.