Bradley J Roth, MD

Primary specialty

Trauma Surgery PhysicianTaxonomy code 2086S0127X

License

G84133 Issued in CA

Practice address

11550 Indian Hills Road,
Suite 310
Mission Hills, CA 91345-1203

Phone

(818) 898-4900

Fax

(818) 898-4990

NPI assigned

Jul 10, 2006

Last updated

Jul 21, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

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

Specialty

General SurgeryAlso: Critical Care (Intensivists)

Education

Saint Louis University School of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Acute Care Surgery Medical Group IncGroup PAC ID 7214006816, 205 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorialcare Long Beach Medical Center Hospital, Long Beach, CA, CCN 050485
• Providence Holy Cross Medical Center Hospital, Mission Hills, CA, CCN 050278

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: broth810355@direct.memorialcare.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Acute Care Surgery Medical Group, Inc.

  • Surgery Physician
  • Sacramento, CA
  • NPI 1700069549
  Medicare reassignment Care Compare group
• Trauma & Critical Care SFV Group Inc

  • Trauma Surgery Physician
  • Mission Hills, CA
  • NPI 1942588868
  Medicare reassignment Authorized official
• Providence Health System - Southern California

  dba Providence Holy Cross Trauma Center

  • Emergency Medicine Physician
  • Mission Hills, CA
  • NPI 1689875601
  Medicare reassignment NPD
• Usc Surgeons, Inc.

  • Surgery Physician
  • Los Angeles, CA
  • NPI 1821034315
  NPD (past)

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

• Long Beach Memorial Medical

  • General Acute Care Hospital
  • Long Beach, CA
  • NPI 1962442012
  Care Compare affiliation
• Providence Health System - Southern California

  dba Providence Holy Cross Medical Center

  • General Acute Care Hospital
  • Mission Hills, CA
  • NPI 1477587632
  Care Compare affiliation

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437436800000",
    "number": "1699709048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25050 AVENUE KEARNY",
            "address_2": "SUITE 208",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913551257",
            "telephone_number": "661-430-0940",
            "fax_number": "661-295-0862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11550 INDIAN HILLS ROAD,",
            "address_2": "SUITE 310",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913451203",
            "telephone_number": "818-898-4900",
            "fax_number": "818-898-4990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "BRADLEY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2015-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "CA",
            "license": "G84133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAL OPTIMA",
            "identifier": "00G841330C29",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G841330",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL BLUE SHIELD",
            "identifier": "00G841330",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "020048518",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Max Enrique Rodriguez, M.D.
• Victoria Flor Rodriguez, BA
• Payam Rohani, M.D.
• Catherine Mary Rosenberger, RPH
• Sky Lea Ross, PSY.D., M.A., LMFT
• Ria Rupp, LCSW
• Kellie S. Russell, D.O.
• Ericka Yvette S. Germon, LMFT
• Michelle Sabino, OTR/L
• Khosro Sadeghani, MD

• Trauma Surgery Physician in Mission Hills, CA
• Providers in Mission Hills, CA by specialty
• Trauma Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; 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.