Individual provider Active NPI

Randall Lynn Roth, D.C.

  • Chiropractor
  • Hot Springs, AR
National Provider Identifier
1417912759
Registry record updated Nov 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1219 Issued in AR
Practice address
804 Higdon Ferry Rd
Hot Springs, AR 71913-6129
Phone
(501) 881-4407
Fax
(501) 881-4407
NPI assigned
Apr 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1219 AR Primary

Addresses

Primary practice location

804 Higdon Ferry Rd
Hot Springs, AR 71913-6129

Mailing address

804 Higdon Ferry Rd
Hot Springs, AR 71913-6129
Phone (501) 881-4407

Other identifiers 1

IdentifierTypeStateIssuer
59741OtherARBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100125000193 AR Practitioner - Chiropractic 3274560479 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

804 Higdon Ferry Rd
Hot Springs, AR 71913-6129

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1219ARMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Randall L. Roth, D.C.-P.C. Chiropractor CurrentSince Jul 19, 2005 Accepting new patients

Locations

804 Higdon Ferry Rd
Hot Springs National Park, AR 71913
Phone (501) 881-4407

305 W Spring Creek Pkwy
Ste 103
Plano, TX 75023
Phone (469) 241-1294

Organizations & group practices 1

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": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257897600000",
    "number": "1417912759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 HIGDON FERRY RD",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719136129",
            "telephone_number": "501-881-4407",
            "fax_number": "501-881-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 HIGDON FERRY RD",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719136129",
            "telephone_number": "501-881-4407",
            "fax_number": "501-881-4407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "RANDALL",
        "middle_name": "LYNN",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2009-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AR",
            "license": "1219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "59741",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hot Springs, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.