NPIMap

Organization Active NPI

Terry R Roth MD PC

  • Clinic/Center
  • Rockford, IL
National Provider Identifier
1265601579
Registry record updated Jun 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
TERRY R ROTH MD PC
Practice address
4920 E State St
Rockford, IL 61108-2272
Phone
(815) 226-1906
Fax
(815) 226-8474
NPI assigned
Feb 21, 2008
Last updated
Jun 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2015

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

Authorized official

Name
Terry R Roth, MDNPI 1215919816
Title
Owner
Phone
(815) 226-1906

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

4920 E State St
Rockford, IL 61108-2272

Mailing address

4920 E State St
Rockford, IL 61108-2272
Phone (815) 226-1906

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1203552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435190400000",
    "number": "1265601579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4920 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082272",
            "telephone_number": "815-226-1906",
            "fax_number": "815-226-8474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082272",
            "telephone_number": "815-226-1906",
            "fax_number": "815-226-8474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TERRY R ROTH MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-21",
        "last_updated": "2015-06-25",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-226-1906",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.