Active NPI
Samuel Benjamin Roth, LAT, ATC
- Sports Physical Therapist
- Sugar Land, TX
National Provider Identifier
1497415731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physical Therapist
- License
- 1357064
- Practice address
- 17520 W Grand Pkwy S Ste 100
Sugar Land, TX 77479-4759 - Phone
- (281) 725-5895
- NPI assigned
- Dec 28, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 1357064 | TX | |
| Athletic Trainer | 2255A2300X | AT8549 | TX | |
| Sports Physical Therapist | 2251S0007X | 1357064 | TX | Primary |
Addresses
Primary practice location
17520 W Grand Pkwy S Ste 100
Sugar Land, TX 77479-4759
Mailing address
3505 W Sam Houston Pkwy S Apt 5404
Houston, TX 77042-2151
Phone (402) 469-1006
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AT8549 | Other | TX | AT LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1357064 | TX | MD | Sports Physical Therapist |
| AT8549 | TX | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hermann Health System | Past | Accepting new patients | |
| Blacketer Enterprises, Inc | Sports | Past | Accepting new patients |
| Agape Physical Therapy Services, PC | Sports | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Community/Retail Pharmacy
- Houston, TX
- NPI 1366229619
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660780800000",
"number": "1497415731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3505 W SAM HOUSTON PKWY S APT 5404",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770422151",
"telephone_number": "402-469-1006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17520 W GRAND PKWY S STE 100",
"city": "SUGAR LAND",
"state": "TX",
"postal_code": "774794759",
"telephone_number": "281-725-5895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "SAMUEL",
"middle_name": "BENJAMIN",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-12-28",
"last_updated": "2022-08-18",
"certification_date": "2022-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "TX",
"license": "1357064",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT8549",
"primary": false
},
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "TX",
"license": "1357064",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AT LICENSE",
"identifier": "AT8549",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sugar Land, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.