Individual provider Active NPI

Robert B Roth, MD

  • Cardiovascular Disease Physician
  • Milwaukee, WI
National Provider Identifier
1386684231
Registry record updated Jun 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
29385 Issued in WI
Practice address
2350 N Lake Dr
Suite 400
Milwaukee, WI 53211-4528
Phone
(414) 271-1633
Fax
(414) 271-5071
NPI assigned
Jun 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 29385 WI Primary

Addresses

Primary practice location

2350 N Lake Dr
Suite 400
Milwaukee, WI 53211-4528

Mailing address

4425 N Port Washington Rd
Attn: Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (414) 271-1633

Other identifiers 1

IdentifierTypeStateIssuer
31421500MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040128000664 WI Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 2961305941 Reassigns benefits to 2 organizations
I20250620000016 MN Practitioner - Cardiovascular Disease (Cardiology) 2961305941 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Tulane University School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Corr Health Wi, SCGroup PAC ID 2163877879, 7 clinicians

Practice addresses (Care Compare)

1433 N Water St
Milwaukee, WI 53202-2557
Phone (646) 830-8707

1650 W End Blvd
Minneapolis, MN 55416-5367
Phone (651) 403-6205

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29385WIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Jan 1, 2007 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince Jan 1, 2007 Accepting new patients
Corr Health Wi, SC CurrentSince Sep 5, 2023 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Past Accepting new patients

Locations

1650 West End Blvd
St Louis Park, MN 55416
Phone (646) 830-8707

961 Broadway
Ste 103
Woodmere, NY 11598
Phone (212) 516-8548

6900 N Port Washington Rd
Glendale, WI 53217
Phone (414) 270-8100

13133 N Port Washington Rd
Ste 202
Mequon, WI 53097
Phone (262) 243-5850

13133 N Port Washington Rd
Ste 118
Mequon, WI 53097
Phone (262) 243-7470

13133 N Port Washington Rd
Mequon, WI 53097
Phone (262) 243-5850

2315 N Lake Dr
Ste 613
Milwaukee, WI 53211
Phone (414) 271-1633

2350 N Lake Dr
Ste 400
Milwaukee, WI 53211
Phone (414) 270-1633

250 E Wisconsin Ave
Milwaukee, WI 53202
Phone (262) 345-3191

250 E Wisconsin Ave
Ste 1800
Milwaukee, WI 53202
Phone (414) 289-7154

1317 W Grand Ave
Prt Washingtn, WI 53074
Phone (262) 268-6998

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Interoperability endpoints

  • Direct secure messaging: robert.roth@672894380343300.direct.elationemr.com

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339459200000",
    "number": "1386684231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 N PORT WASHINGTON RD",
            "address_2": "ATTN: CSMCP CLINIC CREDENTIALING",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121082",
            "telephone_number": "414-271-1633",
            "fax_number": "414-271-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 N LAKE DR",
            "address_2": "SUITE 400",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114528",
            "telephone_number": "414-271-1633",
            "fax_number": "414-271-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "ROBERT",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2012-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "29385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31421500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.