Individual provider Active NPI

Kevin M Roth, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Palo Alto, CA
National Provider Identifier
1679778252
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
A121082 Issued in CA
Practice address
795 El Camino Real
Palo Alto, CA 94301-2302
Phone
(650) 853-2951
NPI assigned
Jun 15, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X A121082 CA
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X A121082 CA Primary

Addresses

Primary practice location

795 El Camino Real
Palo Alto, CA 94301-2302

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408
Phone (650) 853-2951

Other practice location 1

3315 Broadway
Oakland, CA 94611-5717
Phone (510) 486-2300

Other practice location 2

2625 Shadelands Dr
Walnut Creek, CA 94598-2512
Phone (925) 939-8585

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130722000439 CA Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 0941467666 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Sports Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, shared by 16 NPIs, 3,783 clinicians

Practice addresses (Care Compare)

3200 Kearney St
Fremont, CA 94538-2299
Phone (510) 490-1222

370 Distel Cir
Los Altos, CA 94022-1404
Phone (650) 254-5200

701 E El Camino Real
Mountain View, CA 94040-2833
Phone (650) 691-6174

795 El Camino Real
Palo Alto, CA 94301-2302
Phone (415) 600-1020

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)17
Upper limb (arm) arthroscopy (minimally invasive joint repair)36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A121082CAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 9, 2023 Accepting new patients
Golden State Orthopedics & Spine Orthopaedic Surgery CurrentSince Jan 1, 2021 Accepting new patients
Golden State Orthopedics & Spine Orthopaedic Surgery CurrentSince Jan 1, 2021 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 9, 2023 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 9, 2023 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
John Muir Trauma Physicians Billing Service Current Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 9, 2023 Accepting new patients
Golden State Orthopedics & Spine Orthopaedic Surgery Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 9, 2023 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 9, 2023 Accepting new patients
John Muir Trauma Physicians Billing Service CurrentSince Jul 18, 2021 Accepting new patients
Stanford Health Care Tri-Valley Past Accepting new patients
Alta Bates Summit Medical Center Past Accepting new patients
Sequoia Health Services Past Accepting new patients
Golden State Orthopedics & Spine Orthopaedic Surgery Past Accepting new patients
San Ramon Regional Medical Center, LLC Past Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Locations (25 of 31)

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

350 John Muir Pkwy
Ste 155
Brentwood, CA 94513

4000 Dublin Blvd
Ste 100
Dublin, CA 94568
Phone (800) 943-8099

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

3120 Kearney St
Fremont, CA 94538
Phone (650) 498-3600

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

715 Altos Oaks Dr
Los Altos, CA 94024
Phone (650) 934-7010

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

701 E El Camino Real
#1
Mountain View, CA 94040
Phone (650) 404-8440

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

3315 Broadway
Oakland, CA 94611
Phone (510) 486-2300

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

301 Industrial Rd
#1
San Carlos, CA 94070
Phone (650) 404-8455

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

2581 Samaritan Dr
Ste 308
San Jose, CA 95124
Phone (408) 355-1700

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

5201 Norris Canyon Rd
Ste 230
San Ramon, CA 94583
Phone (925) 244-9355

5201 Norris Canyon Rd
Ste 300
San Ramon, CA 94583
Phone (925) 866-8720

200 Porter Dr
Ste 215
San Ramon, CA 94583
Phone (925) 362-2166

200 Porter Dr
Ste 101
San Ramon, CA 94583
Phone (925) 838-1440

Interoperability endpoints

  • Direct secure messaging: kevin.roth.p2@direct.muirortho.nextgenshare.com
  • Direct secure messaging: kevin.roth@direct.muirortho.nextgenshare.com
  • Direct secure messaging: kroth177387@hisp.ehr.sutterhealth.org

Organizations & group practices 21

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.

View all 21

Hospital & facility affiliations 4

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": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1679778252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "650-853-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 EL CAMINO REAL",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943012302",
            "telephone_number": "650-853-2951"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3315 Broadway",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946115717",
            "country_code": "US",
            "telephone_number": "510-486-2300",
            "fax_number": "510-486-2333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2625 Shadelands Dr",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945982512",
            "country_code": "US",
            "telephone_number": "925-939-8585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTH",
        "first_name": "KEVIN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-15",
        "last_updated": "2023-06-06",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A121082",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "A121082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.