Individual provider Active NPI

Jennifer Lobban Roth

  • Family Medicine Physician
  • Bronx, NY
National Provider Identifier
1174805725
Registry record updated Sep 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
390200000X. Issued in NY
Practice address
3450 Wayne Ave
Apt 13H
Bronx, NY 10467-2510
Phone
(305) 979-8001
NPI assigned
Sep 9, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 390200000X. NY Primary

Addresses

Primary practice location

3450 Wayne Ave
Apt 13H
Bronx, NY 10467-2510

Mailing address

3450 Wayne Ave
Apt 13H
Bronx, NY 10467-2510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20181001001219 TX Practitioner - Family Practice 7911159801 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Albert Einstein College of Medicine of Yeshiva University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nluc PLLCGroup PAC ID 3072752302, 219 clinicians
Next Level MV LLCGroup PAC ID 5991062085, 124 clinicians

Practice addresses (Care Compare)

1246 N FM 3083 Rd W
Suite B
Conroe, TX 77304-5340
Phone (281) 783-8162

16312 Southwest Fwy
Sugar Land, TX 77479-2371
Phone (281) 783-8162

4002 FM 762 Rd
Suite 100
Rosenberg, TX 77469-5558
Phone (281) 783-8162

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
390200000X.NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Next Level MV LLC CurrentSince Jul 18, 2018 Accepting new patients
Nluc PLLC CurrentSince Jul 18, 2018 Accepting new patients
Next Level MV LLC Current Accepting new patients
Nluc PLLC CurrentSince Jul 18, 2018 Accepting new patients

Locations

7710 Garth Rd
Ste A
Baytown, TX 77521

6342 Phelan Blvd
Beaumont, TX 77706
Phone (281) 783-7182

1246 N FM 3083 Rd W
Ste B
Conroe, TX 77304

5749 San Felipe St
Houston, TX 77057
Phone (281) 362-7557

4435 Kingwood Dr
Kingwood, TX 77339
Phone (281) 360-7711

101 Winding Way St
Ste A
Lake Jackson, TX 77566

8325 Broadway St
Ste 220
Pearland, TX 77581
Phone (281) 873-8162

4002 FM 762 Rd
Ste 100
Rosenberg, TX 77469

5211 FM 2920 Rd
Ste 101
Spring, TX 77388

16312 Southwest Fwy
Ste 18
Sugar Land, TX 77479

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315526400000",
    "number": "1174805725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 WAYNE AVE",
            "address_2": "APT 13H",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 WAYNE AVE",
            "address_2": "APT 13H",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672510",
            "telephone_number": "305-979-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "JENNIFER",
        "middle_name": "LOBBAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-09",
        "last_updated": "2011-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "390200000X.",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.