Active NPI
Carl J Roth III, OD
- Optometrist
- Great Falls, MT
National Provider Identifier
1174596738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- MT675
- Practice address
- 2800 11TH Ave S Ste 14
Great Falls, MT 59405-5263 - Phone
- (406) 455-2020
- Fax
- (406) 771-6816
- NPI assigned
- Feb 13, 2006
- Last updated
- Dec 8, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | MT675 | MT | Primary |
Addresses
Primary practice location
2800 11TH Ave S Ste 14
Great Falls, MT 59405-5263
Mailing address
2800 11TH Ave S Ste 14
Great Falls, MT 59405-5263
Phone (406) 455-2020
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000027131 | Other | MT | BLUE CROSS BLUE SHIELD |
| 0000481219 | Medicaid | MT | |
| 410042781 | Other | RAILROAD MEDICARE | |
| MSF1137622 | Other | MT | MONTANA STATE FUND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2800 11TH Ave S
14 David a Boes MD
Great Falls, MT 59405-5263
Phone (406) 455-2020
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT675 | MT | MD | Optometrist |
| 675 | MT | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boes Eye Care | Current | Accepting new patients | |
| Carl J Roth OD PC | Optometrist | Current | Accepting new patients |
| Christopher L Paris M D P C | Past | Accepting new patients | |
| Eyecare Professionals - Mountain Eyewear | Optometrist | Past | Accepting new patients |
Locations
113 E Oak St
Ste 2C
Bozeman, MT 59715
Phone (406) 587-2020
120 N 7th Ave
Bozeman, MT 59715
Phone (406) 587-0123
2800 11th Ave S
Ste 14
Great Falls, MT 59405
Phone (406) 455-2020
Organizations & group practices 4
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.
-
- Ophthalmology Physician
- Great Falls, MT
- NPI 1003180217
-
- Specialist
- Billings, MT
- NPI 1003975269
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Benefis Medical Group
- Multi-Specialty Clinic/Center
- Great Falls, MT
- NPI 1780968974
Hospital
-
- General Acute Care Hospital
- Great Falls, MT
- NPI 1881650737
-
dba Great Falls Clinic Hospital
- General Acute Care Hospital
- Great Falls, MT
- NPI 1639109978
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670457600000",
"number": "1174596738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2800 11TH AVE S STE 14",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594055263",
"telephone_number": "406-455-2020",
"fax_number": "406-771-6816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 11TH AVE S STE 14",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594055263",
"telephone_number": "406-455-2020",
"fax_number": "406-771-6816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "CARL",
"middle_name": "J",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-13",
"last_updated": "2022-12-08",
"certification_date": "2022-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MT",
"license": "MT675",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "000027131",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000481219",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410042781",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MONTANA STATE FUND",
"identifier": "MSF1137622",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; 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.
- 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.