NPIMap

Individual provider Active NPI

Jerry M Roth, MD

  • Internal Medicine Physician
  • Southampton, PA
National Provider Identifier
1023014123
Registry record updated Feb 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD030012E Issued in PA
Practice address
501 Street Rd Ste 101
Southampton, PA 18966-3796
Phone
(215) 357-5780
Fax
(215) 364-8983
NPI assigned
Jun 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD030012E PA Primary

Addresses

Primary practice location

501 Street Rd Ste 101
Southampton, PA 18966-3796

Mailing address

501 Street Rd
Southampton, PA 18966-3746
Phone (215) 357-5780

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040121000891 PA Practitioner - Internal Medicine 9032011069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Jefferson Medical College of Thomas Jefferson University, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Einstein Community Health Associates IncGroup PAC ID 7012818008, 196 clinicians

Practice addresses (Care Compare)

101 E Olney Ave
Philadelphia, PA 19120-2470
Phone (215) 927-1937

Hospital & facility affiliations

  • Mercy Home Health Home health agency, Newtown, PA, CCN 397015
  • Jefferson Health at Home by Bayada Home health agency, Horsham, PA, CCN 397145
  • Bayada Home Health Care, Inc. Home health agency, Blue Bell, PA, CCN 398276
  • Bayada Home Health Care, Inc. Home health agency, Jamison, PA, CCN 397791
  • Holy Redeemer Home Care-PA Home health agency, Philadelphia, PA, CCN 397104
  • Doylestown Hospital Hospital, Doylestown, PA, CCN 390203
  • Jefferson Abington Hospital Hospital, Abington, PA, CCN 390231
  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174
  • St Mary Medical Center Hospital, Langhorne, PA, CCN 390258
  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111
  • Willowbrooke Court-Southampton Nursing home, Southampton, PA, CCN 395490

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Einstein Community Health Associates, Inc Internal Medicine CurrentSince Dec 15, 2024 Accepting new patients
Einstein Community Health Associates, Inc CurrentSince Dec 15, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1200 York Rd
Abington, PA 19001
Phone (215) 481-2222

101 E Olney Ave
Ste C5
Philadelphia, PA 19120
Phone (215) 927-1937

501 Street Rd
Ste 101
Southampton, PA 18966
Phone (215) 357-3807

Organizations & group practices 3

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.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518566400000",
    "number": "1023014123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 STREET RD",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189663746",
            "telephone_number": "215-357-5780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 STREET RD STE 101",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189663796",
            "telephone_number": "215-357-5780",
            "fax_number": "215-364-8983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "JERRY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2018-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD030012E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southampton, PA

Sources for this page

Verify at the official NPI Registry.