Daniel Christopher Roth, DO, MBA, MS

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

02003462A Issued in IN

Practice address

1721 Magnavox Way
Fort Wayne, IN 46804-1537

Phone

(260) 748-3650

Fax

(260) 748-3651

NPI assigned

Sep 12, 2007

Last updated

Feb 4, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Physical Medicine and Rehabilitation

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Racc Medical Associates LLCGroup PAC ID 0648424127, 20 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Master of Business Administration, Master of Science

State licenses

Practice roles

Locations

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.

• Racc Medical Associates LLC

  dba Summit Pain Management

  • Physical Medicine & Rehabilitation Physician
  • Fort Wayne, IN
  • NPI 1184976136
  Medicare reassignment Care Compare group NPD Authorized official
• Racc Medical Associates LLC

  dba Summit Pain Management

  • Durable Medical Equipment & Medical Supplies
  • Warsaw, IN
  • NPI 1912666744

  Physical Medicine & Rehabilitation

  NPD Authorized official
• Racc Medical Associates LLC

  • Durable Medical Equipment & Medical Supplies
  • Marion, IN
  • NPI 1013676840
  Authorized official Same address or phone
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692

  Interventional Pain Medicine

  NPD (past)
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732

  Interventional Pain Medicine

  NPD (past)

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549238400000",
    "number": "1861687923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670",
            "city": "HUNTERTOWN",
            "state": "IN",
            "postal_code": "467480670",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 MAGNAVOX WAY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041537",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6811 Lima Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468181145",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2124 N Biomet Dr",
            "address_purpose": "LOCATION",
            "city": "Warsaw",
            "state": "IN",
            "postal_code": "465827858",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1314 E 7th St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "IN",
            "postal_code": "467062533",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2512 E DuPont Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468251609",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTH",
        "first_name": "DANIEL",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "DO, MBA, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-12",
        "last_updated": "2019-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": "125050599",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IN",
            "license": "02003462A",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IN",
            "license": "02003462A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "790872",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200938070",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacy Ross, RN
• Stephen Gerard Ross, PSYD
• Steven Ross, MD
• Helen Catherine Rossman, MS, MSED, NP-C
• Adam Roth, CO
• Meredith Roth, PA-C
• Su Roth
• Theresa L Roth, RN
• Zachary D Roth, O.D.
• Holly Nicole Rothenbush, LMFT

• Physical Medicine & Rehabilitation Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Physical Medicine & Rehabilitation Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; 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.