LUCAS B ROTH (PA-C) – Surgical Physician Assistant, NPI 1083124846
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for LUCAS B ROTH (PA-C)
6000 N ALLEN RD
PEORIA, IL 616143294
Phone: (309) 691-1400
Fax: (309) 693-3197
Type: Mailing
608, West Glen Arbor Way, Bloomington, Monroe County, Indiana, 47403, United States
BLOOMINGTON, IL 617020608
Phone: (309) 662-3311
Fax: (309) 662-7143
Type: Mailing
Trinity Lane, Bloomington, McLean County, Illinois, 61704-2534, United States
BLOOMINGTON, IL 61704
Phone: (309) 663-6461
Fax: (309) 663-5711
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 23 Open Payments records for all available years, with a total value of $768.
Total Amount is formed as General ($768) + Research ($0) + Ownership ($0) = $768.
Last reported payment date: 2024-10-29 • Largest payer in this snapshot: DePuy Synthes Sales Inc. ($704).
Total Amount
$768
General + Research + Ownership
Payments
23
Total payment records
General Amount
$768
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-29
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| DePuy Synthes Sales Inc. | $704 |
| Ferring Pharmaceuticals Inc. | $48 |
| Merck Sharp & Dohme LLC | $16 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-02-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20180206002229 | I | Physician Assistant | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 480 | 56 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 142 | 73 | $0 |
| 27130 | Replacement of thigh bone and hip joint with prosthesis | 99 | 98 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 96 | 87 | $0 |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose | 68 | 24 | $0 |
Insurance plans in this area (ZIP 61614)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | MA | |
| Internal Medicine | VA | |
| Family Practice | GA | |
| Orthopedic Surgery | IL | |
| - | NC | |
| - | TX | |
| Internal Medicine | MA | |
| Family Practice | OR | |
| Nurse Practitioner | WA | |
| Internal Medicine | MA |
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