MELINDA M ROTH (PMHNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1154757045
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
11,632 NURSE PRACTITIONER in IL
Provider Addresses for MELINDA M ROTH (PMHNP)
PO BOX 266
CORNELL, IL 613190266
Phone: (815) 343-9382
Type: Mailing
108 W MARKET ST
BLOOMINGTON, IL 617013918
Phone: (309) 827-5351
Fax: (309) 829-6808
Type: Location
1100 Beech St Bldg 10
Normal, IL 617611493
Phone: (309) 463-5800
Fax: (833) 914-2704
Type: Location
108 W Market St
Bloomington, IL 617013918
Phone: (309) 827-5351
Fax: (309) 829-6808
Type: Location
3144 VANZILE RD
CRANDON, WI 545208149
Phone: (715) 478-5180
Fax: (715) 478-5904
Type: Location
1100 BEECH ST BLDG 10
NORMAL, IL 617611493
Phone: (309) 463-5800
Fax: (833) 914-2704
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2017-09-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20131106001593 | I | Nurse Practitioner | IL | TBD |
| I20170920002093 | I | Nurse Practitioner | WI | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 61319)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | WI | |
| C H I R O P R A C T I C | WI | |
| Nurse Practitioner | WI | |
| Pediatric Medicine | WI | |
| - | WI | |
| Clinical Social Worker | WI | |
| Clinical Social Worker | WI | |
| Family Practice | WI | |
| Mental Health Counselor | WI |
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