MRS. SHOSTY SUE ROTH (PA-C) – Psychiatry Physician, NPI 1740511831
Psychiatry Physician
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MRS. SHOSTY SUE ROTH (PA-C)
28 NW 4TH ST STE A
GRAND RAPIDS, MN 557442714
Phone: (218) 999-7750
Type: Mailing
2215 S 6TH ST
BRAINERD, MN 564015512
Phone: (218) 454-1010
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.
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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: 2010-11-16
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 |
|---|---|---|---|---|
| I20101116000873 | I | Physician Assistant | MN | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 46 | 23 | $0 |
| 90833 | Psychotherapy with evaluation and management visit, 30 minutes | 27 | 15 | $0 |
Insurance plans in this area (ZIP 55744)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MN | |
| Clinical Psychologist | MN | |
| Nurse Practitioner | MN | |
| - | MN | |
| Nurse Practitioner | MN | |
| Nurse Practitioner | MN | |
| Nurse Practitioner | MN |
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