NPIMap

Individual provider Active NPI

Philip Anthony Roth, MD

  • Family Medicine Physician
  • Huntsville, AL
National Provider Identifier
1710968383
Registry record updated Aug 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12141 Issued in AL
Practice address
2089 Cecil Ashburn Dr SE
Suite 101
Huntsville, AL 35802-2567
Phone
(256) 533-3966
Fax
(256) 882-9757
NPI assigned
Nov 9, 2005
Last updated
Aug 21, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2012

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 12141 AL Primary

Addresses

Primary practice location

2089 Cecil Ashburn Dr SE
Suite 101
Huntsville, AL 35802-2567

Mailing address

420 Lowell Dr SE
Suite 103
Huntsville, AL 35801-3754
Phone (256) 535-5940

Other identifiers 4

IdentifierTypeStateIssuer
000085204MedicaidAL
080055438OtherRAILROAD MEDICARE
51085204OtherALBLUE CROSS BLUE SHIELD
0004036975OtherAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20100924000606 AL Practitioner - Family Practice 5890811061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Alabama School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2089 Cecil Ashburn Dr SE
Suite 101
Huntsville, AL 35802-2568
Phone (256) 533-3966

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.45 of 100Reported as apm
Quality
90.9
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12141ALMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Philip a. Roth, Jr., MD/PC Family Medicine CurrentSince Aug 10, 1993 Accepting new patients

Locations

2089 Cecil Ashburn Dr SE
Ste 101
Huntsville, AL 35802
Phone (256) 882-6487

420 Lowell Dr SE
Ste 103
Huntsville, AL 35801
Phone (256) 535-5940

Interoperability endpoints

  • Direct secure messaging: philip.roth.1@13347.direct.athenahealth.com

Organizations & group practices 1

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 6

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": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345507200000",
    "number": "1710968383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 LOWELL DR SE",
            "address_2": "SUITE 103",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358013754",
            "telephone_number": "256-535-5940",
            "fax_number": "256-882-9757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2089 CECIL ASHBURN DR SE",
            "address_2": "SUITE 101",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358022567",
            "telephone_number": "256-533-3966",
            "fax_number": "256-882-9757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "PHILIP",
        "middle_name": "ANTHONY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2012-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "12141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000085204",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080055438",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51085204",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0004036975",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

Verify at the official NPI Registry.