Individual provider Active NPI

James T Roth, M.D.

  • Obstetrics & Gynecology Physician
  • Ontario, OR
National Provider Identifier
1104895705
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
263690-1205 Issued in UT
Practice address
1219 SW 4TH Ave Unit 2
Ontario, OR 97914-4500
Phone
(801) 261-3975
Fax
(801) 262-9142
NPI assigned
Mar 16, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 263690-1205 UT Primary

Addresses

Primary practice location

1219 SW 4TH Ave Unit 2
Ontario, OR 97914-4500

Mailing address

1441 NE 10TH Ave
Payette, ID 83661-5420
Phone (208) 642-9376

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20190515002321 OR Practitioner - Obstetrics/Gynecology 7719034271 Reassigns benefits to 6 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
263690-1205UTMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Family Health Care, Inc CurrentSince May 1, 2020 Accepting new patients
Valley Family Health Care Inc CurrentSince May 1, 2020 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 1, 2025 Accepting new patients
Providence Health & Services Oregon CurrentSince Dec 10, 2024 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Dec 10, 2024 Accepting new patients
Providence Health & Services - Oregon CurrentSince Dec 10, 2024 Accepting new patients
Bay Area Hospital District CurrentSince Sep 20, 2024 Accepting new patients
Providence Health & Services - Oregon CurrentSince Dec 10, 2024 Accepting new patients
Bay Area Hospital District CurrentSince Sep 20, 2024 Accepting new patients
Valley Family Health Care, Inc Current Accepting new patients
Providence Health & Services Oregon CurrentSince Jan 1, 2025 Accepting new patients
Jordan Family Health, LLC Past Accepting new patients
Mountainstar Medical Group-St. Marks Hospital, LLC Past Accepting new patients

Locations

Dept LA 25339
Pasadena, CA 91185

1441 NE 10th Ave
Payette, ID 83661
Phone (208) 642-9376

2650 N 17th St
Coos Bay, OR 97420
Phone (541) 267-5411

1775 Thompson Rd
Coos Bay, OR 97420
Phone (541) 269-8090

940 Royal Ave
Unit 350
Medford, OR 97504
Phone (541) 732-7460

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

17 S 3rd St
Nyssa, OR 97913
Phone (541) 372-5738

896 Fortner St
Ontario, OR 97914
Phone (541) 709-2038

1219 SW 4th Ave
Unit 2
Ontario, OR 97914
Phone (208) 302-2200

725 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000

789 Washington St W
Vale, OR 97918
Phone (503) 473-2101

Organizations & group practices 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1104895705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 NE 10TH AVE",
            "city": "PAYETTE",
            "state": "ID",
            "postal_code": "836615420",
            "telephone_number": "208-642-9376",
            "fax_number": "208-642-9598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 SW 4TH AVE UNIT 2",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979144500",
            "telephone_number": "801-261-3975",
            "fax_number": "801-262-9142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "JAMES",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "UT",
            "license": "263690-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, OR

Sources for this page

Verify at the official NPI Registry.