Gary F Roth, MD
Individual provider Active NPI Emergency Medicine Physician · Bloomington, IL
NPI 1992732648 · NPPES record last updated Sep 18, 2009
Key facts
- NPI
- 1992732648
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 036052934 (IL)
- Practice address
- 2200 E Washington St
Bloomington, IL 61701-4364 - Phone
- (309) 661-5111
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bloomington Medical Laboratory Physicians, S.C. | Current | Accepting new patients | |
| Prairie Emergency Group, LTD. | Past | Accepting new patients | |
| Lafountain Emergency Physicians LLC | Emergency Medicine | Past | Accepting new patients |
| Central Illinois Neuroradiology, LTD | Past | Accepting new patients | |
| Crossroads Emergency Physicians, LLP | Emergency Medicine | Past | Accepting new patients |
| Bestpractices of Illinois PC | Emergency Medicine | Past | Accepting new patients |
| Emcare Physician Providers, Inc. | Emergency Medicine | Past | Accepting new patients |
| Pearl Emergency Physicians | Emergency Medicine | Past | Accepting new patients |
Locations
2200 E Washington St
Bloomington, IL 61701
Phone (309) 662-3311
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 036052934 | IL | Yes |
Addresses
Primary practice location
2200 E Washington St
Bloomington, IL 61701-4364
Mailing address
2538 Momentum PL
Chicago, IL 60689-0001
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036052934 | Medicaid | IL |
Other providers in Bloomington, IL
- Charles Rosen
- Makayla G Rosenbery-Hornbuckle
- Aaron James Rossi
- Carolyn Roth
- Ellen Roth
- Kaitlin Rotholtz
- Michelle Denise Rowell
- Janlyn Rowland
- Tonya Marie Roy
- Crystal L Royal
All providers in Bloomington, IL · Emergency Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.