Angela Ruth Roth, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M-13774 Issued in ID

Practice address

2315 8TH St
Lewiston, ID 83501-7301

Phone

(208) 746-1383

Fax

(208) 746-1383

NPI assigned

Jul 7, 2006

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 identifiers 2

Other names 1

• Angela Ruth Brakhage, Richmond Former name

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

University of Missouri, Columbia School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Catalyst Medical Group PLLCGroup PAC ID 2365722105, 31 clinicians

St Joseph Hospital LLCGroup PAC ID 8325325806, 91 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: angela.roth.1@16883.direct.athenahealth.com
• Direct secure messaging: angela.roth.2@28344.direct.athenahealth.com

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.

• Catalyst Medical Group, PLLC

  • Multi-Specialty Clinic/Center
  • Lewiston, ID
  • NPI 1912458787
  Medicare reassignment Care Compare group NPD
• St Joseph Hospital LLC

  • Internal Medicine Physician
  • Lewiston, ID
  • NPI 1205368404
  Medicare reassignment Care Compare group NPD
• St. Joseph Hospital LLC

  • General Acute Care Hospital
  • Lewiston, ID
  • NPI 1225090954
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1851323950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 8TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835017301",
            "telephone_number": "208-746-1383",
            "fax_number": "208-746-1383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 8TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835017301",
            "telephone_number": "208-746-1383",
            "fax_number": "208-746-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "ANGELA",
        "middle_name": "RUTH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M-13774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2079474",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851323950",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "BRAKHAGE, RICHMOND",
            "middle_name": "RUTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Judith Rooney, LCSW
• Michael Rooney, M.D.
• Rosauers Supermarkets Inc
• Ruth Lauren Ross, LPC
• Amanda Roth
• Brian Rothfusz, R.PH.
• Mark Mitchell Roubidoux II, NP-C
• William Westel Rowe, MD
• Shannon R. Rowland, PMHNP
• Margeret Roy

• Pediatrics Physician in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Pediatrics Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.

Verify at the official NPI Registry.