MEDICARE: DR. ANDREW THOMAS ROTH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	2019019689	MO
2	207R00000X	Internal Medicine Physician	2019019689	MO
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2019019689	MO
4	207RP1001X	Pulmonary Disease Physician	2019019689	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689037194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW THOMAS ROTH MD

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	314-454-8917
Fax Number	:	314-454-7524

Provider Business Practice Location Address
First Line	:	1 BARNES JEWISH HOSPITAL PLZ
Second Line	:	DIV IM PULMONARY AND CRITICAL CARE MEDICINE
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1003
Country	:	US
Telephone Number	:	314-454-8917
Fax Number	:	314-454-7524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2016
Last Update Date	:	05/04/2026

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