NPIMap

Individual provider Active NPI

Matt D Roth, MD

  • Family Medicine Physician
  • Toledo, OH
National Provider Identifier
1457566101
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35088737 Issued in OH
Practice address
2865 N Reynolds Rd Ste 260
Toledo, OH 43615-2070
Phone
(419) 578-4280
Fax
(419) 537-5684
NPI assigned
May 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 35-088737 OH
Family Medicine Physician 207Q00000X 35088737 OH Primary

Addresses

Primary practice location

2865 N Reynolds Rd Ste 260
Toledo, OH 43615-2070

Mailing address

660 Beaver Creek Cir
Suite 110
Maumee, OH 43537-1745
Phone (419) 891-6210

Other identifiers 6

IdentifierTypeStateIssuer
2769839MedicaidOH
05455OtherPARAMOUNT
9202151OtherAETNA
000000571949OtherANTHEM
PENDINGOtherRRMC
PENDINGOtherTRICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mroth14053@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20070702000002 OH Practitioner - Family Practice 3779682836 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

2865 N Reynolds Rd
Suite 260
Toledo, OH 43615-2070
Phone (419) 578-4280

Hospital & facility affiliations

  • Ohioans Home Healthcare, Inc Home health agency, Perrysburg, OH, CCN 368247
  • Med1Care, LLC Home health agency, Findlay, OH, CCN 368362
  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068
  • Promedica Charles and Virginia Hickman Hospital Hospital, Adrian, MI, CCN 230005
  • Bay Park Community Hospital Hospital, Oregon, OH, CCN 360259

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35088737OHMDFamily Medicine Physician
35-088737OHMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Aug 1, 2008 Accepting new patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
The Toledo Hospital Family Medicine CurrentSince May 1, 2007 Accepting new patients
The Toledo Hospital CurrentSince May 1, 2007 Accepting new patients
The Toledo Hospital Current Accepting new patients
Promedica Central Physicians Family Medicine CurrentSince Aug 1, 2008 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

660 Beaver Creek Cir
Ste 110
Maumee, OH 43537
Phone (419) 891-6210

2865 N Reynolds Rd
Ste 260
Toledo, OH 43615
Phone (419) 578-4280

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

Interoperability endpoints

  • Direct secure messaging: mroth14053@direct.promedica.org

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1457566101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 BEAVER CREEK CIR",
            "address_2": "SUITE 110",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371745",
            "telephone_number": "419-891-6210",
            "fax_number": "419-893-3232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 N REYNOLDS RD STE 260",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436152070",
            "telephone_number": "419-578-4280",
            "fax_number": "419-537-5684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "MATT",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "OH",
            "license": "35-088737",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35088737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2769839",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT",
            "identifier": "05455",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9202151",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000571949",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "PENDING",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "PENDING",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mroth14053@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.