LUCAS B ROTH (NPI# 1083124846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083124846 |
| Entity Type | Individual |
| Full Name | LUCAS B ROTH |
| Credential | PA-C |
| Practice Address |
1111 Trinity Ln Ste 111 Bloomington IL 61704 |
| Mailing Address |
Po Box 608 Bloomington IL 61702-0608 |
| Practice Telephone | 3096636461 |
| Practice Fax Number | 3096635711 |
| Mailing Telephone | 3096623311 |
| Mailing Fax Number | 3096627143 |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2018-06-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085006385 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 085006385 | 05 |
| Street Address |
1111 TRINITY LN STE 111 |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609875798 | Kimberly Kelleher Rhoda | Occupational Therapist | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2005-07-20 |
| 1316582273 | Nicole Christine Bermudes | Orthopaedic Surgery | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2019-11-14 |
| 1063054278 | Nicholas Ray Von Holten | Physician Assistant | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2019-10-09 |
| 1134690522 | Matthew A Kresnicka | Physical Therapist | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2018-12-10 |
| 1871082826 | Jessica Amanda Tobias | Student in an Organized Health Care Education/Training Program | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2018-05-04 |
| 1164939179 | Lukas Dominic Manieri | Specialist/Technologist | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2017-12-29 |
| 1467961706 | Sandra A Fader | Nurse Practitioner | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2017-09-28 |
| 1356732101 | Brian A Schrock | Physician Assistant | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2015-02-16 |
| 1144633579 | Ashley R Anderson | Physical Therapist | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2014-06-03 |
| 1801146444 | Jonathon C Crowley | Physical Therapist | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2012-09-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518430859 | Visionpoint Eye Center LLC | Optometrist | 1107 Airport Road, Bloomington, IL 61704 | 2019-01-09 |
| 1922588235 | Geethu Sabu Makil | Speech-Language Pathologist | 1039 Blueheron Way, Apt#3, Bloomington, IL 61704 | 2018-08-16 |
| 1629596812 | Mental Wellness Center Inc | Counselor | 202 N Prospect Rd Ste 207, Bloomington, IL 61704 | 2017-09-07 |
| 1649798513 | Sarah Goodner | Psychologist | 1704 Royal Pointe Drive, Bloomington, IL 61704 | 2017-08-31 |
| 1346760253 | Elizabeth Devlin | Nurse Practitioner | 25 Long Cove Ct, Bloomington, IL 61704 | 2017-06-21 |
| 1396107918 | Darla Schwertfeger | Specialist/Technologist, Other | 2104 Hedgewood Dr, Bloomington, IL 61704 | 2016-03-23 |
| 1740662949 | Oncology Hematology Associates of Central Illinois | Pharmacy | 3105 Magory Drive, Bloomington, IL 61704 | 2015-06-24 |
| 1821478967 | Kelly R Andrews | Massage Therapist | 4101 Wicker Rd, Bloomington, IL 61704 | 2015-06-03 |
| 1235522582 | All Ways Caring Services, Inc. | In Home Supportive Care | 209 S Prospect Rd, Suite 3e, Bloomington, IL 61704 | 2015-03-11 |
| 1396093977 | Bhawna Gupta | Physical Therapist | 2200 East Washington Street, Bloomington, IL 61704 | 2012-08-29 |
| Find all providers in zip 61704 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508496621 | Samantha Jean Mcgough Lamere | Physician Assistant | 4300 Marketpointe Drive, Suite 100, Bloomington, MN 55435 | 2020-01-16 |
| 1386292886 | Quinn Harmon | Physician Assistant | 1310 W Bloomfield Rd Ste C, Bloomington, IN 47403-2001 | 2019-08-28 |
| 1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
| 1487172409 | Melody Ann Bauman | Physician Assistant | 1505 Eastland Dr, Osf Critical Cane, Pulmonary, Sleep M, Bloomington, IL 61701 | 2017-08-30 |
| 1730619487 | Elise Nicole Lill | Physician Assistant | 4300 Market Pte Dr Ste 100, Bloomington, MN 55435-5435 | 2017-06-15 |
| 1528417557 | Kathryn Shalbrack | Physician Assistant | 4300 Marketpointe Dr, Bloomington, MN 55435-5423 | 2016-06-09 |
| 1740634203 | Alfonso Luna IIi | Physician Assistant | 657 S Lancewood Ave, Bloomington, CA 92316-1336 | 2016-04-20 |
| 1215308671 | Sara Ann Houk | Physician Assistant | 2200 E. Washington St, Bloomington, IL 61701-4323 | 2015-10-12 |
| 1760865133 | Patrick D Machacek | Physician Assistant | 10633 Vincent Ave S, Bloomington, MN 55431-3733 | 2015-07-03 |
| 1558740803 | Samuel Johnson | Physician Assistant | 2901 Metro Drive, Suite 527, Bloomington, MN 55122 | 2015-05-20 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 61704 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.