CHRISTINE SUE ROTH (CRNA) – Certified Registered Nurse Anesthetist, NPI 1114972858

CHRISTINE SUE ROTH (CRNA) is a healthcare provider. based in Green bay, Wisconsin. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold the professional credentials CRNA. They hold a License No. D102488 (IA). The NPI Number for CHRISTINE SUE ROTH (CRNA) is 1114972858

Main info

Female
20 Years Of Experience
Accepts Medicare Assignment
Name
CHRISTINE SUE ROTH (CRNA)
NPI
1114972858
Phone
(920) 433-3605
Address
744 S Webster Ave
Enumeration Date
23 May 2006
Last Update Date
17 March 2018

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6087424131
Graduation Year
2006 (20 years ago)
PAC ID
2769494954
Group Practice PAC ID
5799684007
Professional Enrollment ID
I20150909003007
Address ID
WI539019240PO2817XRDXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

1,141 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in WI

Provider Addresses for CHRISTINE SUE ROTH (CRNA)

  • 744 S Webster Ave

    Green Bay, WI 543013504

    Phone: (920) 433-3605

    Fax: (920) 433-3589

    Type: Location

  • Winneshiek Medical Center, 901, Montgomery Street, Decorah, Winneshiek County, Iowa, 52101, United States

    DECORAH, IA 521012325

    Phone: (563) 382-2911

    Fax: (563) 387-3102

    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: 2015-09-09

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20060710000022ICertified Registered Nurse Anesthetist (Crna)IATBD
I20150909003007ICertified Registered Nurse Anesthetist (Crna)WITBD

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.

Verify on CMS Revalidation Lookup Tool

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 54301)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5799684007View full group profile
NameSpecialtyState
Emergency MedicineWI
Physician AssistantWI
Emergency MedicineWI
Physical Medicine And RehabilitationWI
Certified Registered Nurse Anesthetist (Crna)WI
Emergency MedicineWI
Emergency Medicine, Addiction MedicineWI
Physician AssistantWI
Emergency MedicineNY
Hospitalist, Internal MedicineWI

Reviews

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Frequently asked questions

How do I look up CHRISTINE SUE ROTH (CRNA) by NPI?
Use NPI 1114972858 when you need to reference CHRISTINE SUE ROTH (CRNA) in forms, claims, or directories.
Is CHRISTINE SUE ROTH (CRNA)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What field does CHRISTINE SUE ROTH (CRNA) work in?
You can think of CHRISTINE SUE ROTH (CRNA) as practicing within Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
Where does public data place CHRISTINE SUE ROTH (CRNA)?
The snapshot lists Green Bay, Wisconsin for CHRISTINE SUE ROTH (CRNA); download NPPES for the complete set.
How can I contact CHRISTINE SUE ROTH (CRNA)?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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