Nicole Roth, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601006425 Issued in MI

Practice address

1500 Sandpoint Rd
Munising, MI 49862-1406

Phone

(906) 387-4110

NPI assigned

Aug 27, 2012

Last updated

Jul 2, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nicole Aninos Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• 906 Footcare PLLC

  • Physician Assistant
  • Negaunee, MI
  • NPI 1952926412
  NPD Authorized official
• Munising Memorial Hospital Association

  dba Baycare Medical Center

  • Family Medicine Physician
  • Au Train, MI
  • NPI 1205673241

  Physician Assistant

  NPD (past)
• Munising Memorial Hospital Association

  dba Bay Care Medical Center

  • Family Medicine Physician
  • Munising, MI
  • NPI 1629120415
  NPD (past)

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

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372723200000",
    "number": "1831447770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 SANDPOINT RD",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "498621406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SANDPOINT RD",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "498621406",
            "telephone_number": "906-387-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-27",
        "last_updated": "2013-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "ANINOS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kerrie Phillipson
• Jan Hazel Prokosch, FNPC
• Emily Rose Prunick, FNP-C
• Putvin Health Mart of Munising Inc (Putvin Drug Store A Radio Shack Dealer)
• Chelsea Elise Ray, MD
• Walter William Rudzinski, MD
• Kareem Said, M.D.
• Sault Tribe of Chippewa Indians
• George Schultz, R.P.H.
• Joseph Michael Shaw II, D.C.

• Physician Assistant in Munising, MI
• Providers in Munising, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.