Individual provider Active NPI

Christine Sue Roth, CRNA

  • Certified Registered Nurse Anesthetist
  • Decorah, IA
National Provider Identifier
1114972858
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
D102488 Issued in IA
Practice address
901 Montgomery St
Decorah, IA 52101-2325
Phone
(563) 382-2911
Fax
(563) 387-3102
NPI assigned
May 23, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X D102488 IA Primary

Addresses

Primary practice location

901 Montgomery St
Decorah, IA 52101-2325

Mailing address

901 Montgomery St
Decorah, IA 52101-2325
Phone (563) 382-2911

Other practice location 1

744 S Webster Ave
Green Bay, WI 54301-3504
Phone (920) 433-3605

Other identifiers 1

IdentifierTypeStateIssuer
1114972858MedicaidIA

Other names 1

  • Christine Sue Sims Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060710000022 IA Practitioner - Certified Registered Nurse Anesthetist (Crna) 2769494954 Reassigns benefits to 1 organization
I20150909003007 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 2769494954 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Divine Savior Healthcare IncGroup PAC ID 5799684007, 135 clinicians

Practice addresses (Care Compare)

2817 New Pinery Rd
Portage, WI 53901-9240
Phone (608) 742-4131

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.7 of 100Reported as group
Quality
91.14
Promoting interoperability
100
Improvement activities
40
Cost
77.5

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
8233WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Divine Savior Healthcare, Inc. CurrentSince Nov 25, 2024 Accepting new patients
Mercy Clinton Anesthesia Group LLC Nurse Anesthetist, Certified Registered CurrentSince May 26, 2020 Accepting new patients
Tomah Memorial Hospital Inc CurrentSince May 1, 2021 Accepting new patients
Divine Savior Healthcare, Inc. CurrentSince Nov 25, 2024 Accepting new patients
Richland Hospital CurrentSince Mar 24, 2018 Accepting new patients
Richland Hospital CurrentSince Mar 24, 2018 Accepting new patients
Vituity-Wisconsin Anesthesia SC CurrentSince Aug 14, 2024 Accepting new patients
Vituity-Wisconsin Anesthesia SC CurrentSince Aug 14, 2024 Accepting new patients
Tomah Memorial Hospital Inc CurrentSince May 1, 2021 Accepting new patients
Knoxville Area Anesthesia Services Nurse Anesthetist, Certified Registered Past Accepting new patients
Bloomfield Anesthetists Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1410 N 4th St
Clinton, IA 52732
Phone (563) 244-5555

29980 Network Pl
Chicago, IL 60673

400 10th St E
Waconia, MN 55387

9555 76th St
Pleasant Prairie, WI 53158
Phone (262) 577-8000

2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598

333 E 2nd St
Richland Ctr, WI 53581
Phone (608) 647-6161

501 Gopher Dr
Tomah, WI 54660
Phone (608) 371-2181

Organizations & group practices 12

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.

Hospital & facility affiliations 1

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1114972858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MONTGOMERY ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012325",
            "telephone_number": "563-382-2911",
            "fax_number": "563-387-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MONTGOMERY ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012325",
            "telephone_number": "563-382-2911",
            "fax_number": "563-387-3102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "744 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013504",
            "country_code": "US",
            "telephone_number": "920-433-3605",
            "fax_number": "920-433-3589",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTH",
        "first_name": "CHRISTINE",
        "middle_name": "SUE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IA",
            "license": "D102488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114972858",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "SIMS",
            "middle_name": "SUE",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Decorah, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.