Active NPI
Samuel J Roth, PHD
- Psychologist
- Grand Rapids, MI
National Provider Identifier
1992866735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301006951
- Practice address
- 1550 East Beltline SE
Suite 340
Grand Rapids, MI 49506 - Phone
- (616) 831-2000
- Fax
- (616) 831-2001
- NPI assigned
- Dec 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301006951 | MI | Primary |
Addresses
Primary practice location
1550 East Beltline SE
Suite 340
Grand Rapids, MI 49506
Mailing address
1550 East Beltline SE
Suite 340
Grand Rapids, MI 49506
Phone (616) 831-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301006951 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992866735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1550 EAST BELTLINE SE",
"address_2": "SUITE 340",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49506",
"telephone_number": "616-831-2000",
"fax_number": "616-831-2001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1550 EAST BELTLINE SE",
"address_2": "SUITE 340",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49506",
"telephone_number": "616-831-2000",
"fax_number": "616-831-2001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "SAMUEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301006951",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.