NPIMap

Individual provider Active NPI

Julie L Roth, MD

  • Clinical Neurophysiology Physician
  • Providence, RI
National Provider Identifier
1063673713
Registry record updated Dec 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X
License
MD12830 Issued in RI
Practice address
593 Eddy St
Apc-5
Providence, RI 02903-4923
Phone
(401) 444-3032
Fax
(401) 444-3205
NPI assigned
Jun 24, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neurophysiology Physician 2084N0600X MD12830 RI Primary
Neurology Physician 2084N0400X MD12830 RI

Addresses

Primary practice location

593 Eddy St
Apc-5
Providence, RI 02903-4923

Mailing address

15 La Salle SQ
Providence, RI 02903-1814
Phone (401) 444-6779

Other identifiers 2

IdentifierTypeStateIssuer
1063673713MedicaidRI
110084239AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20090701000433 RI Practitioner - Neurology 5991856007 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Warren Alpert Medical School of Brown University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians
Brown NeurologyGroup PAC ID 2163312869, 16 clinicians
Rhode Island HospitalGroup PAC ID 8921900044, 430 clinicians

Practice addresses (Care Compare)

185 A High Service Ave
North Providence, RI 02904-5114
Phone (401) 354-6050

185 High Service Ave
North Providence, RI 02904-5114
Phone (401) 354-6050

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-3032

593 Eddy St Apc
Suite 6
Providence, RI 02903-4923
Phone (401) 793-9172

593 Eddy St George BLDG 1St Floor
Providence, RI 02903-4923
Phone (401) 793-9166

Hospital & facility affiliations

  • Rhode Island Hospital Hospital, Providence, RI, CCN 410007
  • The Miriam Hospital Hospital, Providence, RI, CCN 410012
  • Kent County Memorial Hospital Hospital, Warwick, RI, CCN 410009

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Hospital CurrentSince Feb 2, 2026 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Mar 29, 2015 Accepting new patients
Rhode Island Hospital CurrentSince Feb 2, 2026 Accepting new patients
Brown Neurology Neurology CurrentSince Jul 1, 2009 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Mar 29, 2015 Accepting new patients
Lifespan Corporation Current Accepting new patients
Rhode Island Hospital Past Accepting new patients
Lifespan Physician Group, Inc. Neurology Past Accepting new patients

Locations

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

79 Turnpike Ave
Portsmouth, RI 02871
Phone (401) 683-7434

2 Dudley St
Ste 555
Providence, RI 02905
Phone (401) 444-4169

593 Eddy St
Ste 5
Providence, RI 02903
Phone (401) 444-3996

15 La Salle Sq
Providence, RI 02903

593 Eddy St
Providence, RI 02903

110 Elm St
Fl 1
Providence, RI 02903

593 Eddy St
#5
Providence, RI 02903
Phone (401) 444-3032

Interoperability endpoints

  • Direct secure messaging: jroth12126@brownhealth.medalliesdirect.net

Organizations & group practices 20

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.

View all 20

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766016000000",
    "number": "1063673713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LA SALLE SQ",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029031814",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "APC-5",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-3032",
            "fax_number": "401-444-3205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "JULIE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-24",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "RI",
            "license": "MD12830",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "RI",
            "license": "MD12830",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063673713",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110084239A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.