Individual provider Active NPI

Elizabeth B Roth, M.D.

  • Pediatric Urology Physician
  • Milwaukee, WI
National Provider Identifier
1982925327
Registry record updated Jul 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
63705 Issued in WI
Practice address
9000 W Wisconsin Ave
Pediatric Urology
Milwaukee, WI 53226-4874
Phone
(414) 266-3794
Fax
(414) 266-1752
NPI assigned
Jun 21, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 63705 WI
Pediatric Urology Physician 2088P0231X 63705 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave
Pediatric Urology
Milwaukee, WI 53226-4874

Mailing address

9000 W Wisconsin Ave
Pediatric Urology
Milwaukee, WI 53226-4874
Phone (414) 266-3794

Other practice location 1

2575 E Evergreen Drive
Appleton, WI 54913-8904
Phone (920) 969-5353

Other practice location 2

555 Redbird Cir
DE Pere, WI 54115-7977
Phone (920) 969-5353

Other identifiers 1

IdentifierTypeStateIssuer
1982925327MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20160711001366 WI Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 3375772759 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Pediatric Medicine
Education
Washington University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Childrens Specialty Group IncGroup PAC ID 2567813447, 206 clinicians

Practice addresses (Care Compare)

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
63705WIMDPediatric Urology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Specialty Group, Inc. CurrentSince Jun 21, 2024 Accepting new patients
MCHS Hospitals Inc Current Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Jul 1, 2016 Accepting new patients

Locations

2575 E Evergreen Dr
Appleton, WI 54913
Phone (920) 969-5353

555 Redbird Cir
De Pere, WI 54115
Phone (920) 338-6820

2550 S Ashland Ave
Green Bay, WI 54304
Phone (920) 548-7337

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

Interoperability endpoints

  • Direct secure messaging: elizabeth.roth@marshfieldclinichealthsystem.cernerdirect.com
  • Direct secure messaging: eroth851093@direct.froedtert.com
  • Direct secure messaging: eroth38888@direct.chw.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1277078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1982925327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC UROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3794",
            "fax_number": "414-266-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC UROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3794",
            "fax_number": "414-266-1752"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2575 E Evergreen Drive",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549138904",
            "country_code": "US",
            "telephone_number": "920-969-5353",
            "fax_number": "414-337-7201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "555 Redbird Cir",
            "address_purpose": "LOCATION",
            "city": "DE Pere",
            "state": "WI",
            "postal_code": "541157977",
            "country_code": "US",
            "telephone_number": "920-969-5353",
            "fax_number": "414-337-7201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTH",
        "first_name": "ELIZABETH",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-21",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WI",
            "license": "63705",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "WI",
            "license": "63705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982925327",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.