Robert Eric Roth, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2177 Issued in TN

Practice address

2333 Knob Creek Rd
Suite 11
Johnson City, TN 37604-2007

Phone

(423) 952-0500

Fax

(423) 952-0005

NPI assigned

Sep 29, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TN

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, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Robert E Roth PSYDGroup PAC ID 4880670538, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Robert E Roth PSYD

  • Clinical Psychologist
  • Johnson City, TN
  • NPI 1679593040
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992792519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 KNOB CREEK RD",
            "address_2": "SUITE 11",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042007",
            "telephone_number": "423-952-0500",
            "fax_number": "423-952-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 KNOB CREEK RD",
            "address_2": "SUITE 11",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042007",
            "telephone_number": "423-952-0500",
            "fax_number": "423-952-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "ROBERT",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "2177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - MEDICAL",
            "identifier": "4076590",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3689027",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - BEHAVIORAL HEALTH",
            "identifier": "4037912",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "TN0101",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Wayne Ross, M.D.
• James A Ross, MD
• Kellie Ann Ross, MA, NCC
• Samuel G Ross, DPT
• Leah Elizabeth Roth, MSW
• Linda Hall Rothery, DNP, FNP-BC
• Alexander Craig Rothy, M.D.
• Ann Maria Gebka Rouse, MD
• Elizabeth Rouzee
• Rowan Enterprises Inc

• Psychologist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.