Individual provider Active NPI

Virginia Roth, MSW

  • Clinical Social Worker
  • Bend, OR
National Provider Identifier
1790237352
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L8552 Issued in OR
Practice address
2084 NE Professional CT
Bend, OR 97701-6077
Phone
(541) 383-3005
Fax
(541) 383-1883
NPI assigned
Oct 31, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X S.1500639 OH
Clinical Social Worker 1041C0700X L8552 OR Primary

Addresses

Primary practice location

2084 NE Professional CT
Bend, OR 97701-6077

Mailing address

600 SW Columbia St Ste 6250
Bend, OR 97702-1099
Phone (541) 383-3005

Other practice location 1

11059 E Bethany Dr
Aurora, CO 80014-2622
Phone (303) 617-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S.1500639OHMDSocial Worker
L8552ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mosaic Community Health CurrentSince Aug 24, 2020 Accepting new patients

Locations

11059 E Bethany Dr
Ste 200
Denver, CO 80014
Phone (303) 617-2331

11059 E Bethany Dr
Denver, CO 80014
Phone (303) 617-2342

600 SW Columbia St
Ste 6250
Bend, OR 97702

2084 NE Professional Ct
Bend, OR 97701
Phone (541) 322-5753

375 NW Beaver St
Ste 101
Prineville, OR 97754
Phone (541) 316-6026

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1477872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1790237352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SW COLUMBIA ST STE 6250",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021099",
            "telephone_number": "541-383-3005",
            "fax_number": "541-383-1883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2084 NE PROFESSIONAL CT",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016077",
            "telephone_number": "541-383-3005",
            "fax_number": "541-383-1883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11059 E Bethany Dr",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800142622",
            "country_code": "US",
            "telephone_number": "303-617-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTH",
        "first_name": "VIRGINIA",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-31",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1500639",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L8552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.