NPIMap

Individual provider Active NPI

Kenneth J. Roth, M.D.

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1750475562
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G52650 Issued in CA
Practice address
8765 Aero Drive
Suite 130
San Diego, CA 92123-1767
Phone
(858) 541-0181
Fax
(858) 430-0919
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G52650 CA Primary

Addresses

Primary practice location

8765 Aero Drive
Suite 130
San Diego, CA 92123-1767

Mailing address

8695 Spectrum Center Blvd Ste 130
San Diego, CA 92123-1489
Phone (858) 541-0181

Other identifiers 2

IdentifierTypeStateIssuer
00G526500MedicaidCA
BJ295YOtherCAMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20080331000258 CA Practitioner - Internal Medicine 9032003090 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
State University of New York at Buffalo School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Focus on Health IncGroup PAC ID 0648624254, 63 clinicians

Practice addresses (Care Compare)

San Diego, CA 92123
Phone (858) 541-0181

8765 Aero Dr
Suite 130
San Diego, CA 92123-1767
Phone (858) 541-0181

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G52650CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Focus on Health Inc CurrentSince Mar 1, 2024 Accepting new patients
San Diego Specialists Kenneth J Roth Gen PTR Current Accepting new patients
Ken Roth MD & Rolf Ehlers MD San Diego Internal Medicine Assoc CurrentSince Jul 1, 1992 Accepting new patients
San Diego Hospitalist Associates Inc CurrentSince Sep 14, 2010 Accepting new patients
Emergency and Acute Care Medical Corporation CurrentSince Sep 1, 2007 Accepting new patients

Locations

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

8765 Aero Dr
Ste 130
San Diego, CA 92123
Phone (858) 541-0181

8695 Spectrum Center Ct
San Diego, CA 92123
Phone (858) 499-3025

2790 Truxtun Rd
Ste 100
San Diego, CA 92106
Phone (619) 610-9790

3003 Health Center Dr
San Diego, CA 92123
Phone (858) 939-4185

8765 Aero Dr
Ste 300
San Diego, CA 92123
Phone (858) 541-0181

Interoperability endpoints

  • Direct secure messaging: kroth33551@sharphealthcare.direct-ci.com

Organizations & group practices 5

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 10

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1750475562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8695 SPECTRUM CENTER BLVD STE 130",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231489",
            "telephone_number": "858-541-0181",
            "fax_number": "760-705-1533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8765 AERO DRIVE",
            "address_2": "SUITE 130",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231767",
            "telephone_number": "858-541-0181",
            "fax_number": "858-430-0919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "KENNETH",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G52650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G526500",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "BJ295Y",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.