NPIMap

Individual provider Active NPI

Bobbi Lee Roth, FNP

  • Family Nurse Practitioner
  • Tualatin, OR
National Provider Identifier
1558890848
Registry record updated Jun 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201702881NP-PP Issued in OR
Practice address
19250 SW 65TH Ave Ste 110
Tualatin, OR 97062-7707
Phone
(503) 692-1805
NPI assigned
Jun 8, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 201702881NP-PP OR Primary

Addresses

Primary practice location

19250 SW 65TH Ave Ste 110
Tualatin, OR 97062-7707

Mailing address

2222 NW Lovejoy St
Ste 505
Portland, OR 97210-5103
Phone (503) 242-9850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, NV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170726003296 OR Practitioner - Nurse Practitioner 5395015127
I20180626001517 NV Practitioner - Nurse Practitioner 5395015127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peng MD PLLCGroup PAC ID 8628304813, 3 clinicians

Practice addresses (Care Compare)

500 Damonte Ranch Pkwy
Suite 1030
Reno, NV 89521-5968
Phone (775) 432-6189

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
58.19 of 100Reported as group
Quality
83.42
Improvement activities
0
Cost
71.47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Peng MD PLLC CurrentSince Sep 23, 2019 Accepting new patients
Northwest Neurological & Neurovascular Services PastSince Jul 2, 2018 Accepting new patients

Locations

500 Damonte Ranch Pkwy
Ste 1030
Reno, NV 89521
Phone (775) 432-6189

Interoperability endpoints

  • Direct secure messaging: broth@pmp-nv.direct.office.nextgen.com

Organizations & group practices 2

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497830400000",
    "number": "1558890848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST",
            "address_2": "STE 505",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105103",
            "telephone_number": "503-242-9850",
            "fax_number": "503-226-3539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19250 SW 65TH AVE STE 110",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627707",
            "telephone_number": "503-692-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "BOBBI LEE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-08",
        "last_updated": "2017-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201702881NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tualatin, OR

Sources for this page

Verify at the official NPI Registry.