Brian William Roth, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05007103A Issued in IN

Practice address

510 N Grandstaff Dr
Auburn, IN 46706

Phone

(260) 927-9270

Fax

(260) 927-9272

NPI assigned

Nov 27, 2006

Last updated

Apr 8, 2010By the provider in NPPES

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 6

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Michigan Medical School, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Choice Physical TherapyGroup PAC ID 5496148389, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Choice Physical Therapy

  • Physical Therapy Clinic/Center
  • Auburn, IN
  • NPI 1689332868

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Choice Physical Therapy Southwest LLC

  • Physical Therapy Clinic/Center
  • North Manchester, IN
  • NPI 1992591416

  Physical Therapist

  NPD (past)
• Indiana Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Bluffton, IN
  • NPI 1629110192

  Physical Therapist

  NPD (past)
• QHG of Fort Wayne Company, LLC

  • Physical Therapist
  • Fort Wayne, IN
  • NPI 1508967266
  NPD (past)
• Redimed Dekalb LLC

  • General Practice Physician
  • Auburn, IN
  • NPI 1669417457

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270684800000",
    "number": "1033285846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4251 LAHMEYER RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468155676",
            "telephone_number": "260-432-4700",
            "fax_number": "260-459-9262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 N GRANDSTAFF DR",
            "city": "AUBURN",
            "state": "IN",
            "postal_code": "46706",
            "telephone_number": "260-927-9270",
            "fax_number": "260-927-9272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "BRIAN",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2010-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05007103A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "35179001202",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4423623",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARMONY",
            "identifier": "N299947",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200189290A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000350992",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "1424",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul B Richardson, PTA
• Emily Rinaldi, OTD, OTR/L
• Errin Lyn Ritter, PTA
• Hannah Rosales, OT
• Jacob Rosner
• RX Optical Laboratories, Inc.
• Nicole M Sanderson, NP
• Amy Scheeringa, CNS
• Tabitha D Scherer, LMT, HHP
• Gary A. Scheumann, D.D.S.

• Physical Therapist in Auburn, IN
• Providers in Auburn, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.