NPIMap

Individual provider Active NPI

Taylor Roth, M.D.

  • Emergency Medicine Physician
  • Nellis AFB, NV
National Provider Identifier
1437684057
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
25015 Issued in NV
Practice address
4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600
Phone
(702) 653-2273
NPI assigned
Apr 21, 2017
Last updated
Jun 4, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 27856 MS
Emergency Medicine Physician 207P00000X 25015 NV Primary

Addresses

Primary practice location

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600

Mailing address

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600
Phone (702) 653-2273

Other practice location 1

4505 S Maryland Pkwy
Las Vegas, NV 89154-9900
Phone (702) 895-3011

Other identifiers 1

IdentifierTypeStateIssuer
1437684057MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240405003700 NV Practitioner - Emergency Medicine 4385918416 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shadow Emergency Physicians PLLCGroup PAC ID 2860667375, 105 clinicians

Practice addresses (Care Compare)

1800 W Charleston Blvd
Las Vegas, NV 89102-2329
Phone (702) 383-2000

6625 N 5TH St
North Las Vegas, NV 89084-1341
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27856MSMDEmergency Medicine Physician
25015NVMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Feb 21, 2024 Accepting new patients
Shadow Emergency Physicians PLLC Emergency Medicine Current Accepting new patients
Vituity-Nevada Medical Services Koury & Partners PC Emergency Medicine Current Accepting new patients
University Medical Center of Southern Nevada CurrentSince Jul 1, 2024 Accepting new patients
Vituity-Nevada Medical Services Koury & Partners PC Emergency Medicine CurrentSince Aug 1, 2024 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Jul 1, 2024 Accepting new patients
Vituity-Nevada Medical Services Koury & Partners PC Emergency Medicine CurrentSince Aug 1, 2024 Accepting new patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Feb 21, 2024 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

102 E Lake Mead Pkwy
Henderson, NV 89015
Phone (701) 564-2622

3001 Saint Rose Pkwy
Henderson, NV 89052
Phone (702) 615-5000

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

4980 W Sahara Ave
Ste 100
Las Vegas, NV 89146
Phone (702) 216-7365

620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506

6625 N 5th St
North Las Vegas, NV 89084
Phone (702) 369-7671

Interoperability endpoints

  • Direct secure messaging: troth@direct.mhg.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1437684057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4505 S Maryland Pkwy",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891549900",
            "country_code": "US",
            "telephone_number": "702-895-3011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTH",
        "first_name": "TAYLOR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-21",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "27856",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "25015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437684057",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nellis AFB, NV

Sources for this page

Verify at the official NPI Registry.