Active NPI
John T. Roth, AU.D.
- Audiologist
- Fort Worth, TX
National Provider Identifier
1225039571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 50455
- Practice address
- 904 Pennsylvania Ave
Fort Worth, TX 76104-2225 - Phone
- (817) 332-8817
- Fax
- (817) 332-8827
- NPI assigned
- Aug 9, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 50455 | TX | Primary |
Addresses
Primary practice location
904 Pennsylvania Ave
Fort Worth, TX 76104-2225
Mailing address
904 Pennsylvania Ave
Fort Worth, TX 76104-2225
Phone (817) 332-8817
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 514030 | Other | TX | BCBS DIAG |
| 015430-0111 | Other | TX | PACIFICARE |
| 0616049 | Other | TX | AETNA |
| 2313884 | Other | TX | UNITED HEALTHCARE |
| 4189557 | Other | TX | CHESAPEAKE LIFE |
| 01726 | Other | TX | NECP, HEAR USA |
| 519929 | Other | TX | BCBS DME |
| 015311-0202 | Other | TX | SECUREHORIZONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050510000375 | TX | Practitioner - Qualified Audiologist | 4082654009 | Practice locations: Fort Worth, TX |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50455 | TX | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198108800000",
"number": "1225039571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "904 PENNSYLVANIA AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761042225",
"telephone_number": "817-332-8817",
"fax_number": "817-332-8827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 PENNSYLVANIA AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761042225",
"telephone_number": "817-332-8817",
"fax_number": "817-332-8827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "JOHN",
"middle_name": "T.",
"credential": "AU.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-09",
"last_updated": "2007-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "TX",
"license": "50455",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS DIAG",
"identifier": "514030",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFICARE",
"identifier": "015430-0111",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0616049",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2313884",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHESAPEAKE LIFE",
"identifier": "4189557",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NECP, HEAR USA",
"identifier": "01726",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS DME",
"identifier": "519929",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SECUREHORIZONS",
"identifier": "015311-0202",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.