Mark R Roth, PHD, HSPP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20010291 Issued in IN

Practice address

333 N Alabama St
Suite 350
Indianapolis, IN 46204-2034

Phone

(317) 459-6755

NPI assigned

Jun 15, 2006

Last updated

Nov 24, 2014By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Dr. Mark Roth and Associates

  • Psychologist
  • Indianapolis, IN
  • NPI 1689354573
  NPD Authorized official

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416787200000",
    "number": "1881638690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 W 106TH ST",
            "address_2": "STE 125-125",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460327720",
            "telephone_number": "317-459-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N ALABAMA ST",
            "address_2": "SUITE 350",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462042034",
            "telephone_number": "317-459-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "MARK",
        "middle_name": "R",
        "credential": "PHD, HSPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2014-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20010291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200045300",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason David Roth, PA
• Jennifer Michelle Roth, LMHCA
• Joshua David Roth, M.D.
• Kristin Leigh Roth, DPT
• Kyle Martin Roth, M.D.
• Misty Roth, FNP-BC
• Nathan Veryl Roth, M.D.
• Nathaniel R Roth
• Trenton D Roth, M.D.
• Viola Roth

• Clinical Psychologist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2014; 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.