Physician Compare National (NPI:1619957065)

HEALTHCARE PROVIDER: BERNARD JOHANNES ROTH MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1619957065
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577746544
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110329000447
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROTH
	Individual professional last name
Provider First Name	BERNARD
	Individual professional first name
Provider Middle Name	JOHANNES
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CRITICAL CARE (INTENSIVISTS)
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	PULMONARY DISEASE
	Second secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CRITICAL CARE (INTENSIVISTS), PULMONARY DISEASE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	MEMORIAL PHYSICIANS PLLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	4789733494
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	113
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	303 HOLTON AVE
	Group Practice or individual's line 1 address
City	YAKIMA
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	989023239
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5095757653
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	500036
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	YAKIMA VALLEY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y