Active NPI
William G Roth, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Venice, FL
National Provider Identifier
1124027362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- ME53084
- Practice address
- 446 Tamiami TRL S
2ND Floor
Venice, FL 34285-2625 - Phone
- (941) 483-3319
- Fax
- (941) 483-3406
- NPI assigned
- Jul 19, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cytopathology Physician | 207ZC0500X | ME53084 | FL | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | ME53084 | FL | Primary |
| Clinical Pathology/Laboratory Medicine Physician | 207ZP0105X | ME53084 | FL |
Addresses
Primary practice location
446 Tamiami TRL S
2ND Floor
Venice, FL 34285-2625
Mailing address
446 Tamiami TRL S
2ND Floor
Venice, FL 34285-2625
Phone (941) 483-3319
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 250574600 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100805000171 | FL | Practitioner - Pathology | 0345381950 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME53084 | FL | MD | Cytopathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278028800000",
"number": "1124027362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "446 TAMIAMI TRL S",
"address_2": "2ND FLOOR",
"city": "VENICE",
"state": "FL",
"postal_code": "342852625",
"telephone_number": "941-483-3319",
"fax_number": "941-483-3406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "446 TAMIAMI TRL S",
"address_2": "2ND FLOOR",
"city": "VENICE",
"state": "FL",
"postal_code": "342852625",
"telephone_number": "941-483-3319",
"fax_number": "941-483-3406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "WILLIAM",
"middle_name": "G",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-19",
"last_updated": "2010-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "207ZC0500X",
"taxonomy_group": "",
"desc": "Pathology, Cytopathology",
"state": "FL",
"license": "ME53084",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "FL",
"license": "ME53084",
"primary": true
},
{
"code": "207ZP0105X",
"taxonomy_group": "",
"desc": "Pathology, Clinical Pathology/Laboratory Medicine",
"state": "FL",
"license": "ME53084",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "250574600",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Venice, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.