Donald Norman Roth, PSY D, APNP is a medicare enrolled "Psychologist - Clinical" in Elm Grove, Wisconsin. His current practice location is
13500 Watertown Plank Road, Elm Grove, Wisconsin. You can reach out to his office (for appointments etc.) via phone at
(847) 340-5785.
Donald Norman Roth is licensed to practice in Wisconsin (license number 2724-57) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1336224989.
Provider's Profile
| Full Name | Donald Norman Roth |
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| Gender | Male |
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| Speciality | Psychologist - Clinical |
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| Location | 13500 Watertown Plank Road, Elm Grove, Wisconsin |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1336224989
- Provider Enumeration Date: 10/25/2006
- Last Update Date: 11/30/2022
Medicare PECOS Information:
- PECOS PAC ID: 9537153416
- Enrollment ID: I20230721001168
Medical Identifiers
Medical identifiers for Donald Norman Roth such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1336224989 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 7902-33 (Wisconsin) | Secondary |
| 103TC0700X | Psychologist - Clinical | 2724-57 (Wisconsin) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Donald Norman Roth allows following entities to bill medicare on his behalf.
| Entity Name | Resilient Journey Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1649970757
PECOS PAC ID: 4688034614
Enrollment ID: O20230721001293 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Donald Norman Roth is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Donald Norman Roth, PSY D, APNP
2630 9th Avenue,
South Milwaukee, WI 53172-3216
Ph: (847) 340-5785 | Donald Norman Roth, PSY D, APNP
13500 Watertown Plank Road,
Elm Grove, WI 53122-2222
Ph: (847) 340-5785 |
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