Roth Bun Ea

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

E5893 Issued in CA

Practice address

635 Anderson Rd Ste 19
Davis, CA 95616-3505

Phone

(530) 758-1810

Fax

(530) 758-1896

NPI assigned

Apr 2, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Basso Podiatry Group IncGroup PAC ID 3577894682, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• California Pacific Medical Center- Van Ness Campus Hospital, San Francisco, CA, CCN 050047

Merit-based Incentive Payment System (MIPS)

Final score

75.75 of 100Reported as individual

Quality

55.9

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rea641764@hisp.ehr.sutterhealth.org

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.

• Basso Podiatry Group, Inc

  • Podiatrist
  • Davis, CA
  • NPI 1841851201

  Foot & Ankle Surgery

  Medicare reassignment Care Compare group NPD
• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Davis, CA
  • NPI 1770532608
  NPD (past)
• Holy Cross Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1962425611
  NPD (past)
• Presbyterian Healthcare Services

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1215913470
  NPD (past)

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

• Sutter Bay Hospitals

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1740348929
  Care Compare affiliation

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

{
    "created_epoch": "1491091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1467984096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 ANDERSON RD STE 19",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956163505",
            "telephone_number": "530-758-1810",
            "fax_number": "530-758-1896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 ANDERSON RD STE 19",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956163505",
            "telephone_number": "530-758-1810",
            "fax_number": "530-758-1896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EA",
        "first_name": "ROTH",
        "middle_name": "BUN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-02",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E5893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "E5893",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Dutulescu, RD
• Thomas Joseph Dworkis, PHARMD
• Catherine Elizabeth Dycaico, M.D.
• David A. Dycaico, MD
• Elisabeth Minori Dyogi
• Brenda Easter
• Charles Matthew Easton, PHARM.D
• Nancy Gail Edgar, LCSW
• Travis Ediger, PT
• Karen Edmiston, M.A. CCC

• Foot & Ankle Surgery Podiatrist in Davis, CA
• Providers in Davis, CA by specialty
• Foot & Ankle Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.