Individual provider Active NPI

Larissa Ann Roth, CNP

  • Family Nurse Practitioner
  • Youngstown, OH
National Provider Identifier
1669855615
Registry record updated Sep 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.17618 Issued in OH
Practice address
1001 Belmont Ave
Youngstown, OH 44504-1003
Phone
(330) 744-2118
Fax
(330) 744-2110
NPI assigned
Jul 8, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2019

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 APRN.CNP.17618 OH Primary

Addresses

Primary practice location

1001 Belmont Ave
Youngstown, OH 44504-1003

Mailing address

1001 Belmont Ave
Youngstown, OH 44504-1003
Phone (330) 744-2118

Other identifiers 1

IdentifierTypeStateIssuer
0137805MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150806011244 OH Practitioner - Nurse Practitioner 5294049037 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Physicians Youngstown Specialty Care LLCGroup PAC ID 3476950296, 463 clinicians

Practice addresses (Care Compare)

1001 Belmont Ave
Youngstown, OH 44504-1003
Phone (330) 747-6446

1044 Belmont Ave
Youngstown, OH 44504-1006

410 W 10TH Ave
Columbus, OH 43210-1240
Phone (614) 293-8000

Hospital & facility affiliations

  • MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN.CNP.17618OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Youngstown LLC CurrentSince Aug 3, 2015 Accepting new patients
Mercy Health Physicians Youngstown, LLC CurrentSince Aug 3, 2015 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients

Locations

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

1001 Belmont Ave
Youngstown, OH 44504
Phone (330) 747-1106

540 Parmalee Ave
Ste 510
Youngstown, OH 44510
Phone (330) 743-1928

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

250 E Federal St
Fl 4
Youngstown, OH 44503
Phone (330) 884-7010

Interoperability endpoints

  • Direct secure messaging: lroth36729@direct.bsmhealth.org

Organizations & group practices 4

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 2

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": "1436313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1669855615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445041003",
            "telephone_number": "330-744-2118",
            "fax_number": "330-744-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445041003",
            "telephone_number": "330-744-2118",
            "fax_number": "330-744-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "LARISSA",
        "middle_name": "ANN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-08",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.17618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0137805",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.