Michelle L Roth (NPI# 1477743813, PAC ID# 8123115821) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1477743813 |
| PAC ID by PECOS | 8123115821 |
| Professional Enrollment ID | I20071026000752 |
| Full Name | Michelle L Roth |
| Organization Legal Name | SODERSTROM DERMATOLOGY CENTER S C |
| Address |
60 S Soangetaha Rd Galesburg IL 61401-7524 |
| Phone Number | 3093445777 |
| Gender | F |
| Graduation Year | 2007 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 2062432651 |
| Number of Group Practice Members | 18 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140209 | METHODIST MEDICAL CENTER OF ILLINOIS |
| 140067 | OSF SAINT FRANCIS MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 2315 Roosevelt St, Clinton, IA 52732-2412 | 5632423571 | SODERSTROM DERMATOLOGY CENTER S C |
| 1800 E 54th St B, Davenport, IA 52807-2852 | 5633447546 | SODERSTROM DERMATOLOGY CENTER S C |
| 60 S Soangetaha Rd, Galesburg, IL 61401-7524 | 3093445777 | SODERSTROM DERMATOLOGY CENTER S C |
| 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 3096747546 | SODERSTROM DERMATOLOGY CENTER S C |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| MIPS_EC_047_overall | Care Plan | 3% | |
| MIPS_EC_137_overall | Melanoma: Continuity of Care - Recall System | 51% | |
| MIPS_EC_138_overall | Melanoma: Coordination of Care | 48% | |
| MIPS_EC_224_overall | Melanoma: Overutilization of Imaging Studies in Melanoma | 98% | |
| MIPS_EC_402_overall | Tobacco Use and Help with Quitting Among Adolescents | 89% | |
| MIPS_EC_431_overall | Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling | 84% |
| Organization Legal Name | SODERSTROM DERMATOLOGY CENTER S C |
| Physicians | 18 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nour Almardini | Pathology | Soderstrom Dermatology Center S C | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 |
| James M Jeffries Iii | Plastic and Reconstructive Surgery | Soderstrom Dermatology Center S C | 60 S Soangetaha Rd, Galesburg, IL 61401-7524 |
| Carl W Soderstrom Jr. | Dermatology | Soderstrom Dermatology Center S C | 2315 Roosevelt St, Clinton, IA 52732-2412 |
| Stuart H Berryman | Physician Assistant | Soderstrom Dermatology Center S C | 2200 Marquette Rd, Peru, IL 61354-1547 |
| Carissa L Pardekooper | Physician Assistant | Soderstrom Dermatology Center S C | 2315 Roosevelt St, Clinton, IA 52732-2412 |
| Joy M Watson | Physician Assistant | Soderstrom Dermatology Center S C | 2315 Roosevelt St, Clinton, IA 52732-2412 |
| Chen Wang | Pathology | Soderstrom Dermatology Center S C | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 |
| Jennifer G Tomelden | Physician Assistant | Soderstrom Dermatology Center S C | 2200 Marquette Rd, Peru, IL 61354-1547 |
| John E Lomax | Plastic and Reconstructive Surgery | Soderstrom Dermatology Center S C | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 |
| Katherine E Shindelar | Physician Assistant | Soderstrom Dermatology Center S C | 2315 Roosevelt St, Clinton, IA 52732-2412 |
| Street Address |
60 S SOANGETAHA RD |
| City | GALESBURG |
| State | IL |
| Zip | 61401-7524 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| James M Jeffries Iii | Plastic and Reconstructive Surgery | Soderstrom Dermatology Center S C | 60 S Soangetaha Rd, Galesburg, IL 61401-7524 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Denise M Johnson Dechow | Psychiatry | Knox Clinic Corp | 834 N Seminary St, Galesburg, IL 61401-0500 |
| Yekaterina Fayn | Internal Medicine | Knox Clinic Corp | 834 N Seminary St, Suite 404, Galesburg, IL 61401-0500 |
| Tyson R Kinnick | Physician Assistant | Knox Clinic Corp | 834 N Seminary St, Galesburg, IL 61401-0500 |
| Harsha S Mehta | Family Practice | Knox Clinic Corp | 834 N Seminary St, Suite 404, Galesburg, IL 61401-0500 |
| Shrikant A Mehta | Family Practice | Knox Clinic Corp | 834 N Seminary St, Galesburg, IL 61401-0500 |
| Mark E Davis | General Surgery | Knox Clinic Corp | 834 N Seminary, Suite 501, Galesburg, IL 61401-0501 |
| Kimberly A Cheek | Nurse Practitioner | Knox Clinic Corp | 834 N Seminary St, Suite 502, Galesburg, IL 61401-0501 |
| Amy Mefford | Certified Nurse Midwife | Knox Clinic Corp | 834 N Seminary, Suite 501, Galesburg, IL 61401-0501 |
| Daniel K Piper | Obstetrics/gynecology | Knox Clinic Corp | 834 N Seminary St, Suite 502, Galesburg, IL 61401-0501 |
| Yufan Chen | Obstetrics/gynecology | Knox Clinic Corp | 834 N Seminary St, Galesburg, IL 61401-0501 |
| Find all physicians in zip 61401 | |||
| City | GALESBURG |
| Zip Code | 61401 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | GALESBURG + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Michelle L Roth.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.