NPIMap

Individual provider Active NPI

John D Roth, M.D.

  • Family Medicine Physician
  • Broad Top, PA
National Provider Identifier
1699772673
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD047424L Issued in PA
Practice address
4133 Medical Center Dr
Broad Top, PA 16621-9001
Phone
(814) 635-2916
Fax
(814) 635-2918
NPI assigned
Jul 5, 2005
Last updated
Jun 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD047424L PA Primary

Addresses

Primary practice location

4133 Medical Center Dr
Broad Top, PA 16621-9001

Mailing address

4133 Medical Center Dr
Broad Top, PA 16621-9001
Phone (814) 635-2916

Other identifiers 16

IdentifierTypeStateIssuer
000742911OtherPAHIGHMARK BCBS
007017627-0002MedicaidPA
007017627-0005MedicaidPA
30803027OtherPAAMERIHEALTH CARITAS
30802890OtherPAAMERIHEALTH CARITAS
30802912OtherPAAMERIHEALTH CARITAS
007017627-0010MedicaidPA
7715310OtherPAAETNA / COVENTRY
007017627-0007MedicaidPA
30707170OtherPAAMERIHEALTH CARITAS
007017627-0009MedicaidPA
007017627-0004MedicaidPA
P02157142OtherPARAILROAD MEDICARE
206707OtherPAUPMC
30802932OtherPAAMERIHEALTH CARITAS
007017627-0006MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101110001201 PA Practitioner - Family PracticePractitioner - Emergency Medicine 4284829631 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
JC Edwards School of Medicine, Marshall University, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6678 Towne Ctr Blvd
Huntingdon, PA 16652-6934
Phone (814) 643-1232

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD047424LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Broad Top Area Medical Center Inc Current Accepting new patients
Broad Top Area Medical Center Inc CurrentSince Oct 14, 2018 Accepting new patients
Broad Top Area Medical Center Inc CurrentSince Oct 14, 2018 Accepting new patients
Broad Top Area Medical Center Inc PastSince Aug 1, 2021 Accepting new patients
Broad Top Area Medical Center Inc PastSince Nov 1, 2019 Accepting new patients
Broad Top Area Medical Center, Inc PastSince May 25, 2021 Accepting new patients

Locations

375 S Kishacoquillas St
Belleville, PA 17004
Phone (717) 935-2065

4133 Medical Center Dr
Broad Top, PA 16621
Phone (814) 506-8463

358 Seminary St
Cassville, PA 16623
Phone (814) 448-9226

1225 Warm Springs Ave
Huntingdon, PA 16652
Phone (814) 643-8206

6674 Towne Center Blvd
Huntingdon, PA 16652
Phone (814) 643-1232

6678 Towne Center Blvd
Huntingdon, PA 16652
Phone (814) 506-8490

790 Bryan St
#2
Huntingdon, PA 16652
Phone (814) 506-8114

814 Washington St
Huntingdon, PA 16652
Phone (814) 623-4415

95 S Park St
Mount Union, PA 17066
Phone (814) 542-8627

626 Water St
Ste 1
Orbisonia, PA 17243
Phone (814) 447-5556

Interoperability endpoints

  • Direct secure messaging: j.roth@broadtopmedical.medentdirect.com

Ownership & related parties

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Broad Top Area Medical Center IncBroad Top, PA, CCN 391853 Federally qualified health center Corporate Officer
Corporate Director
Operational/Managerial Control		 Nov 30, 2018
Nov 30, 2018
Nov 30, 2018
Btamc Trough Creek Medical CenterCassville, PA, CCN 391087 Federally qualified health center Corporate Officer
Corporate Director		 Nov 30, 2018
Nov 30, 2018
Broad Top Area Medical Center IncHuntingdon, PA, CCN 391085 Federally qualified health center Corporate Officer
Corporate Director		 Nov 30, 2018
Nov 30, 2018
Broad Top Area Medical Center IncHuntingdon, PA, CCN 391086 Federally qualified health center Corporate Officer Nov 30, 2018
Btamc Mt Union Medical CenterMount Union, PA, CCN 391106 Federally qualified health center Corporate Officer
Corporate Director		 Nov 30, 2018
Nov 30, 2018
Broad Top Area Medical Center IncHuntingdon, PA, CCN 391121 Federally qualified health center Contracted Managing Employee
Corporate Director		 Nov 30, 2018
Nov 30, 2018
Broad Top Area Medical Center IncHuntingdon, PA, CCN 391144 Federally qualified health center Corporate Officer
Corporate Director		 Dec 1, 2018
Dec 1, 2018
Btamc Family Wellness CenterHuntngdon, PA, CCN 391185 Federally qualified health center Corporate Officer
Operational/Managerial Control		 Dec 1, 2018
Dec 1, 2018
Btamc Belleville Wellness CenterBelleville, PA, CCN 731875 Federally qualified health center Corporate Officer Dec 1, 2018
Btamc Southern Huntingdon Medical CenterOrbisonia, PA, CCN 731942 Federally qualified health center Corporate Officer
Operational/Managerial Control		 Dec 1, 2018
Dec 1, 2018
Btamc Inc Shcmc Dental ClinicOrbisonia, PA, CCN 731001 Federally qualified health center Corporate Officer Dec 1, 2018
Juniata Valley Btamc ClinicAlexandria, PA, CCN 391072 Federally qualified health center Corporate Officer Dec 1, 2018

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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.

Hospital & facility affiliations 12

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": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1699772673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4133 MEDICAL CENTER DR",
            "city": "BROAD TOP",
            "state": "PA",
            "postal_code": "166219001",
            "telephone_number": "814-635-2916",
            "fax_number": "814-635-2918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4133 MEDICAL CENTER DR",
            "city": "BROAD TOP",
            "state": "PA",
            "postal_code": "166219001",
            "telephone_number": "814-635-2916",
            "fax_number": "814-635-2918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "JOHN",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD047424L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BCBS",
            "identifier": "000742911",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007017627-0002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007017627-0005",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH CARITAS",
            "identifier": "30803027",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH CARITAS",
            "identifier": "30802890",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH CARITAS",
            "identifier": "30802912",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007017627-0010",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA / COVENTRY",
            "identifier": "7715310",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007017627-0007",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH CARITAS",
            "identifier": "30707170",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007017627-0009",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007017627-0004",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P02157142",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPMC",
            "identifier": "206707",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH CARITAS",
            "identifier": "30802932",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007017627-0006",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broad Top, PA

Sources for this page

Verify at the official NPI Registry.