MACKENZIE LYNN ROTH (PA) – Medical Physician Assistant, NPI 1831765759
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,854 PHYSICIAN ASSISTANT in MO
Provider Addresses for MACKENZIE LYNN ROTH (PA)
800 STE GENEVIEVE DR
STE GENEVIEVE, MO 636701434
Phone: (573) 883-7781
Fax: (573) 883-4411
Type: Mailing
255 BODERMAN
BLOOMSDALE, MO 636279099
Phone: (573) 483-2929
Fax: (573) 483-9612
Type: Location
255 Boderman
Bloomsdale, MO 636279099
Phone: (573) 483-2929
Fax: (573) 483-9612
Type: Location
PO BOX 776084
CHICAGO, IL 606776084
Phone: (636) 543-2328
Fax: (636) 543-2329
Type: Mailing
5194 JEREMIAH BLVD
HILLSBORO, MO 630505815
Phone: (636) 543-2328
Fax: (636) 543-2329
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $128.
Total Amount is formed as General ($128) + Research ($0) + Ownership ($0) = $128.
Last reported payment date: 2024-09-05 • Largest payer in this snapshot: Novo Nordisk Inc ($111).
Total Amount
$128
General + Research + Ownership
Payments
3
Total payment records
General Amount
$128
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novo Nordisk Inc | $111 |
| AstraZeneca Pharmaceuticals LP | $17 |
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: 2022-05-09
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 |
|---|---|---|---|---|
| I20210817000335 | I | Physician Assistant | MO | TBD |
| I20220509001892 | I | Physician Assistant | TX | 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 |
|---|---|---|---|---|
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 130 | 13 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 62 | 57 | $0 |
| 87428 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus and influenza | 62 | 59 | $0 |
| 87880 | Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) | 43 | 40 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 39 | 39 | $0 |
Insurance plans in this area (ZIP 63670)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MO | |
| Internal Medicine | MO | |
| Nurse Practitioner | MO | |
| - | MO | |
| - | IL | |
| - | MO | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MO | |
| Physical Medicine And Rehabilitation | MO | |
| - | MO | |
| Nurse Practitioner | MO |
Reviews
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