TERRY R ROTH MD PC (NPI# 1265601579) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265601579 |
| Entity Type | Organization |
| Organization Name | TERRY R ROTH MD PC |
| Practice Address |
4920 E State St Rockford IL 61108-2272 |
| Practice Telephone | 8152261906 |
| Practice Fax Number | 8152268474 |
| Mailing Telephone | 8152261906 |
| Mailing Fax Number | 8152268474 |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2015-06-25 |
| Authorized Official Name | TERRY R ROTH (OWNER) |
| Authorized Official Telephone | 8152261906 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | PTAN | 629800 | 01 |
| IL | BCBS | 10132303 | 01 |
| Street Address |
4920 E STATE ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61108-2272 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770565905 | Madhav K Srivastava | Psychiatry & Neurology | 4920 E State St, Rockford, IL 61108-2272 | 2005-11-15 |
| 1679197768 | Dasheka Arkon Morris | Social Worker | 4920 E State St, Rockford, IL 61108-2272 | 2020-06-03 |
| 1215565353 | Cassandra A Barnett | Social Worker | 4920 E State St, Rockford, IL 61108-2272 | 2020-04-01 |
| 1679138622 | Lindsey Rae Williams | Counselor | 4920 E State St, Rockford, IL 61108-2272 | 2019-05-06 |
| 1336647171 | Tamara Alice Vodnansky | Social Worker | 4920 E State St, Rockford, IL 61108-2272 | 2018-01-26 |
| 1316307382 | Brittney Hensley | Social Worker | 4920 E State St, Rockford, IL 61108-2272 | 2016-03-03 |
| 1558619072 | Annette May | Social Worker | 4920 E State St, Rockford, IL 61108-2272 | 2012-08-15 |
| 1437470655 | Tender Loving Care Services Midwest, LLC | Home Health | 4920 E State St, Suite 2, Rockford, IL 61108-2272 | 2010-06-22 |
| 1194815290 | Uma Srivastava | Psychiatry & Neurology | 4920 E State St, Rockford, IL 61108-2272 | 2006-10-13 |
| 1891767224 | Mohammed S Afzal | Psychiatry & Neurology | 4920 E State St, Rockford, IL 61108-2272 | 2006-02-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952862617 | Isr Enterprises, Inc. | Homemaker | 129 Phelps Ave, Bldg 10, Ste 1008, Rockford, IL 61108 | 2019-03-26 |
| 1003306465 | Adrienne Nicole Black | Behavior Technician | 519 Woodland Dr, Woodland Dr, Rockford, IL 61108 | 2018-05-11 |
| 1184085201 | Integrative Healing Center, LLC | Clinic/Center | 6019 Fincham Drive, Rockford, IL 61108 | 2016-03-17 |
| 1730547936 | Perryville Dentist PC | Dentist | 845 S Perryville Rd, Unit 119, Rockford, IL 61108 | 2016-02-02 |
| 1023489853 | Nicole Ping Ticknor | Counselor | 433 S. Phelps Ave., Suite 2, Rockford, IL 61108 | 2015-10-20 |
| 1275940348 | Northwest Home Care, Inc. | Home Health | 1437 S. Bell School Road, Suite 7, Rockford, IL 61108 | 2014-07-21 |
| 1487072922 | Alecia Greenlee | Psychiatry & Neurology | Rosecrance Community Mental Health, 3815 Harrison Avenue, Rockford, IL 61108 | 2014-04-02 |
| 1871925446 | Maria Laura Gustafson | Interpreter | 3208 Wesleyan Ave., Rockford, IL 61108 | 2013-08-06 |
| 1346582822 | Joseph Peevey | Pathology | 5666 E State Street, Department of Pathology, Rockford, IL 61108 | 2013-03-21 |
| 1134466923 | James Henry Peck | Hearing Instrument Specialist | 2424 Charles St, Rockford, IL 61108 | 2013-01-14 |
| Find all providers in zip 61108 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568069805 | Elite Spine & Wellness Center, Inc | Clinic/Center | 5898 Pathfinder Rd, Rockford, IL 61109-4008 | 2020-10-08 |
| 1932227931 | Osborne Wellness Center, Sc | Clinic/Center | 7384 Countryshire Ln, Rockford, IL 61107-2772 | 2007-03-27 |
| 1639715923 | Creek Counseling | Clinic/Center | 6653 Weaver Rd, Rockford, IL 61114-8025 | 2019-11-21 |
| 1437676731 | Rockford Wellness Associates, Sc | Clinic/Center | 6019 Fincham Dr, Rockford, IL 61108-2550 | 2017-08-28 |
| 1770999872 | Healthworks Medical Group of Illinois S C | Clinic/Center | 2801 S Springfield Ave, Rockford, IL 61102-4205 | 2014-07-09 |
| 1255618732 | Jeanne M Flesch PC | Clinic/Center | 415 S Mulford Rd, Rockford, IL 61108-3011 | 2011-11-10 |
| 1295982973 | Brauer Family Chiropractic, Inc. | Clinic/Center | 7264 Argus Dr, Rockford, IL 61107-5837 | 2008-08-25 |
| 1710099270 | Rebound Physical Therapy Center PC | Clinic/Center | 3616 N Main St, Rockford, IL 61103-2159 | 2006-08-31 |
| 1750376638 | Miller Eye Center Ltd | Clinic/Center | 2995 Eastrock Dr, Rockford, IL 61109-1737 | 2005-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407453236 | Dirsi, Inc | Clinic/Center | 2112 N Dayton St, Chicago, IL 60614-4302 | 2020-10-05 |
| 1588261770 | Mount Sinai Community Foundation Dba Sinai Medical Group | Clinic/Center | 2701 W 68th St Fl 3, Chicago, IL 60629-1813 | 2020-10-01 |
| 1013514298 | Mount Sinai Community Foundation Dba Sinai Medical Group | Clinic/Center | 1500 S Fairfield Ave Fl 4, Chicago, IL 60608-1782 | 2020-10-01 |
| 1841804879 | Chicago Poly Clinic LLC | Clinic/Center | 2446 W Devon Ave, Chicago, IL 60659-1913 | 2020-09-08 |
| 1386258226 | Ortho Spine Surgical LLC | Clinic/Center | 1925 E 95th St Ste 220, Chicago, IL 60617-4710 | 2020-09-08 |
| 1821607425 | Desired Medical Services Incorporated | Clinic/Center | 371 Mackinaw Ave, Calumet City, IL 60409-2524 | 2020-07-29 |
| 1639787823 | Md Infusions, Pllc | Clinic/Center | 666 Dundee Rd Ste 1800, Northbrook, IL 60062-2727 | 2020-07-14 |
| 1407474083 | Staten Family Practice Pllc | Clinic/Center | 500 W Virginia Ave, Gillespie, IL 62033-1025 | 2020-07-09 |
| 1629696679 | Serenity Internal Medicine & Wellness Center | Clinic/Center | 3330 W 177th St # 2d-1, Hazel Crest, IL 60429-2184 | 2020-07-07 |
| 1407473663 | Champion Chiropractic PC | Clinic/Center | 148 S Bloomingdale Rd Ste 107e, Bloomingdale, IL 60108-1491 | 2020-07-02 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on TERRY R ROTH MD PC.
| 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.