Active NPI
Deborah Ann Roth, PA-C
- Physician Assistant
- Winston Salem, NC
National Provider Identifier
1811651573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-11752
- Practice address
- 170 Kimel Park Dr
Winston Salem, NC 27103-6946 - Phone
- (336) 768-1270
- NPI assigned
- Oct 27, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-11752 | NC | Primary |
Addresses
Primary practice location
170 Kimel Park Dr
Winston Salem, NC 27103-6946
Mailing address
4601 Park Rd Ste 300
Charlotte, NC 28209-2290
Phone (704) 323-2918
Other practice location 1
Medical Center Boulevard
Winston Salem, NC 27157-0001
Phone (336) 716-2011
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Wake Forest University School of Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
170 Kimel Park Dr
Winston Salem, NC 27103-6946
Phone (704) 323-2276
1915 Randolph Rd
Charlotte, NC 28207-1101
Phone (704) 323-2282
Hospital & facility affiliations
- Novant Health Forsyth Medical Center
- Lifebrite Community Hospital of Stokes
- Northern Regional Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 99.15 of 100
- Promoting interoperability
- 99
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-11752 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergeortho PA | Physician Assistant | Current | Accepting new patients |
| Orthocarolina | Physician Assistant | Current | Accepting new patients |
| Emergeortho PA | Current | Accepting new patients | |
| Orthocarolina, PA | Physician Assistant | Current | Accepting new patients |
| Pinnacle Medical Group, Inc. | Past | Accepting new patients |
Locations
4601 Park Rd
Ste 300
Charlotte, NC 28209
Phone (704) 323-2090
1915 Randolph Rd
Charlotte, NC 28207
Phone (704) 339-1000
1130 N Church St
Ste 100
Greensboro, NC 27401
Phone (336) 375-2300
799 Doctors Ct
Roxboro, NC 27573
Phone (336) 599-4079
170 Kimel Park Dr
Winston Salem, NC 27103
Phone (336) 765-7058
Interoperability endpoints
- droth815189@direct.novanthealth.org
- deborah.roth.1@847.direct.athenahealth.com
Organizations & group practices 7
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.
-
- Orthopaedic Surgery Physician
- Charlotte, NC
- NPI 1497704217
-
- Family Medicine Physician
- Burlington, NC
- NPI 1437860889
-
- Durable Medical Equipment & Medical Supplies
- Eden, NC
- NPI 1841170222
-
- Urgent Care Clinic/Center
- Salinas, CA
- NPI 1669557930
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Winston Salem, NC
- NPI 1447200233
-
- Critical Access Hospital
- Danbury, NC
- NPI 1396288999
-
- General Acute Care Hospital
- Mount Airy, NC
- NPI 1366449282
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744588800000",
"number": "1811651573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 PARK RD STE 300",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282092290",
"telephone_number": "704-323-2918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "170 KIMEL PARK DR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271036946",
"telephone_number": "336-768-1270"
}
],
"practiceLocations": [
{
"address_1": "Medical Center Boulevard",
"address_purpose": "LOCATION",
"city": "Winston Salem",
"state": "NC",
"postal_code": "271570001",
"country_code": "US",
"telephone_number": "336-716-2011",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROTH",
"first_name": "DEBORAH",
"middle_name": "ANN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-27",
"last_updated": "2025-04-14",
"certification_date": "2025-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-11752",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2025; 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.