TED M. ROTH MD
NPI 1174503866
Obstetrics & Gynecology - Urogynecology and Reconstructive Pelvic Surgery in South Bend, IN

Active since January 19, 2006PECOS EnrolledAccepts Medicare Assignment
621 MEMORIAL DR STE 302, SOUTH BEND, IN 46601(574) 367-3800(574) 367-3801 Get Directions Write a Review

NPPES record last updated: January 3, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 3, 2025, Jun 25, 2024, Apr 5, 2021 and 3 more (6 updates tracked since 2018).

About Ted M. Roth Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TED M. ROTH MD (NPI 1174503866) is an individual urogynecology and reconstructive pelvic surgery provider in South Bend, Indiana, licensed in Indiana (01081226A) and active in the NPI registry since January 2006. He is enrolled in Medicare PECOS, is affiliated with University Of Mississippi Med Center, and maintains a secondary practice location in South Bend.

NPPES Registry Identity

NPI1174503866
Entity TypeIndividualMale
Primary Taxonomy207VF0040X
Provider Legal NameTED M. ROTHCredential: MD
Location Address621 MEMORIAL DR STE 302South Bend, IN 46601-1073
Mailing Address1115 Burns StSouth Bend, IN 46617-4403
Fax(574) 367-3801
Sole ProprietorNo
Medical School CMSOtherGraduated 1996
Enumeration DateJanuary 19, 2006
Last NPPES UpdateJanuary 3, 20256 updates tracked since enumeration
NPPES CertifiedJanuary 3, 2025
NPI 1174503866 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyObstetrics & Gynecology · Urogynecology and Reconstructive Pelvic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207VF0040X
License Licensed in IN · 01081226A
Definition

A subspecialist in Urogynecology and Reconstructive Pelvic Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them.

Also ListedObstetrics & GynecologyTaxonomy 207V00000X · License 01081226A (IN)
621 MEMORIAL DR STE 302, South Bend, IN 46601

Secondary Practice Location 1

Location 1100 Navarre Pl Ste 4470South Bend, IN 46601-1168 · Phone (574) 367-3800 · Fax (574) 367-3801

Other Identifiers 1

Medicaid300020434IN

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Ted M. Roth Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1658321898
PECOS Enrollment IDI20250723004473
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
97 services78 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
88 services88 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
51 services47 patients
Diagnostic exam of bladder and urethra using an endoscope 52000
This procedure involves using a thin, flexible tube with a light, called an endoscope, to examine the bladder and urethra. It helps in identifying any abnormalities or issues that may be causing discomfort or other symptoms.
50 services50 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
48 services47 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
33 services33 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

University Of Mississippi Med Center

Acute Care Hospitals · Jackson, MS
2/5 CMS rating
OwnershipGovernment - State
CMS Certification Number250001
Location2500 N State StJackson, MS 39216 · Hinds County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46601 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$122.49 typical visit price
range $53.07 – $161.76
Typical copayment $30.62 (range $13.26 – $40.44)
Most-billed visit code 99204
Established Patient
$66.48 typical visit price
range $16.93 – $132.22
Typical copayment $16.62 (range $4.23 – $33.05)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Lubricant, individual sterile packet, each A4332
DME-Medical/Surgical Supplies · category DA000N
1 supplier12 claims720 services$0.11 avg. paid by Medicare
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each A4351
DME-Orthotic Devices · category DF008N
1 supplier12 claims720 services$1.49 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine (Critical Care Medicine)
621 MEMORIAL DR STE 302
SOUTH BEND, IN 46601
Nurse Practitioner (Family)
621 MEMORIAL DR STE 302
SOUTH BEND, IN 46601
Obstetrics & Gynecology (Urogynecology and Reconstructive Pelvic Surgery)
621 MEMORIAL DR STE 302
SOUTH BEND, IN 46601
Internal Medicine (Critical Care Medicine)
621 MEMORIAL DR STE 302
SOUTH BEND, IN 46601

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ted Roth's NPI number?

The NPI number for Ted Roth is 1174503866. It was assigned to this individual provider in the NPPES registry on January 19, 2006.

Where is Ted Roth located?

Ted Roth practices at 621 Memorial Dr Ste 302, South Bend, IN 46601. The listed phone number is (574) 367-3800.

What is Ted Roth's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology, specializing in Urogynecology and Reconstructive Pelvic Surgery, with taxonomy code 207VF0040X.

Is Ted Roth enrolled in Medicare?

Yes. Ted Roth is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Ted Roth affiliated with any hospitals?

According to CMS data, Ted Roth is affiliated with University Of Mississippi Med Center.

When was this NPI record last updated?

The NPPES record for Ted Roth was last updated on January 3, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.