Individual provider Active NPI

Spencer Amos Roth, DO

  • Internal Medicine Physician
  • Boca Raton, FL
National Provider Identifier
1154903656
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21370 Issued in FL
Practice address
7100 Camino Real Ste 110
Boca Raton, FL 33433-5510
Phone
(561) 750-2338
NPI assigned
Apr 23, 2021
Last updated
Aug 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 21370 FL Primary

Addresses

Primary practice location

7100 Camino Real Ste 110
Boca Raton, FL 33433-5510

Mailing address

10880 W Sample Rd Apt 5401
Coral Springs, FL 33065-2726

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241004002984 FL Practitioner - Internal Medicine 3870995897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cora Health Services IncGroup PAC ID 1759290992, shared by 21 NPIs, 1,125 clinicians
Ima of South Florida LLCGroup PAC ID 6406820414, 30 clinicians

Practice addresses (Care Compare)

7015 Beracasa Way
Cora Physical Therapy W Boca Raton
Boca Raton, FL 33433-3453
Phone (561) 939-2033

7100 Camino Real
Boca Raton, FL 33433-5510
Phone (561) 750-2338

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21370FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ima of South Florida LLC Internal Medicine CurrentSince Sep 3, 2024 Accepting new patients

Locations

1601 Clint Moore Rd
Ste 115
Boca Raton, FL 33487
Phone (561) 939-0760

7100 Camino Real
Ste 110
Boca Raton, FL 33433
Phone (561) 362-9748

Interoperability endpoints

  • Direct secure messaging: spencer.roth.1@31574.direct.athenahealth.com

Organizations & group practices 1

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 4

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": "1619136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1154903656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10880 W SAMPLE RD APT 5401",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330652726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7100 CAMINO REAL STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334335510",
            "telephone_number": "561-750-2338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "SPENCER",
        "middle_name": "AMOS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-23",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "21370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.