Joanna Belle Roth, M.S., A.C.N.P.-B.C.
Individual provider Active NPI Nurse Practitioner · Goshen, IN
NPI 1194975466 · NPPES record last updated Feb 6, 2024
Key facts
- NPI
- 1194975466
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 71002933A (IN)
- Practice address
- 21764 Omega CT
Goshen, IN 46528-7809 - Phone
- (574) 891-4920
- Fax
- (574) 891-4902
- NPI assigned
- Sep 24, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131202001586 | IN | Practitioner - Nurse Practitioner | 2668534363 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71002933A | IN | MD | Obesity Medicine (Preventive Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pic Indiana PC | Current |
Accepting new patients | |
| Crossroads Health & Cosmetic Center PC | Nurse Practitioner | Current | Accepting new patients |
| Oncology Care Associates, PLLC | Past | Accepting new patients |
Locations
21764 Omega Ct
Goshen, IN 46528
Phone (574) 875-4227
924 W Pike St
Goshen, IN 46526
Phone (574) 312-7056
505 W Cleveland Rd
Mishawaka, IN 46545
Phone (574) 235-3135
1245 E Ireland Rd
#B
South Bend, IN 46614
Phone (574) 312-7022
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obesity Medicine (Preventive Medicine) Physician | 2083B0002X | 71002933A | IN | |
| Acute Care Nurse Practitioner | 363LA2100X | 71002933A | IN | |
| Nurse Practitioner | 363L00000X | 71002933A | IN | Yes |
Addresses
Primary practice location
21764 Omega CT
Goshen, IN 46528-7809
Mailing address
21764 Omega CT
Goshen, IN 46528-7809
Phone (574) 891-4920
Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.