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KELLY ANN ROTH MD
NPI 1346892270
Internal Medicine in Urbana, IL

Active since July 11, 2019PECOS EnrolledAccepts Medicare Assignment
611 W PARK ST, URBANA, IL 61801(217) 383-4633 Get Directions Write a Review

NPPES record last updated: June 13, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 13, 2025, Jul 11, 2019 (2 updates tracked since 2019).

About Kelly Ann Roth Md NPPES

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

KELLY ANN ROTH MD (NPI 1346892270) is an individual internal medicine provider in Urbana, Illinois, licensed in Illinois (036159787) and active in the NPI registry since July 2019. She is enrolled in Medicare PECOS, is affiliated with Graham Hospital Association, and is a graduate of Southern Illinois University School Of Medicine (2019).

NPPES Registry Identity

NPI1346892270
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameKELLY ANN ROTHCredential: MD
Location Address611 W PARK STUrbana, IL 61801-2529
Mailing Address611 W Park StUrbana, IL 61801-2529
Phone(217) 383-4633
Sole ProprietorYes
Medical School CMSSouthern Illinois University School Of MedicineGraduated 2019
Enumeration DateJuly 11, 2019
Last NPPES UpdateJune 13, 20252 updates tracked since enumeration
NPPES CertifiedJune 13, 2025
✔ NPI 1346892270 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in IL · 036159787
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X · License 036159787 (IL)
Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X · License 036159787 (IL)
611 W PARK ST, Urbana, IL 61801
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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

Kelly Ann 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 ID648507350
PECOS Enrollment IDI20250623000511
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.

Hospital Affiliations CMS Care Compare 5

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

Graham Hospital Association

Acute Care Hospitals · Canton, IL
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140001
Location210 West Walnut StreetCanton, IL 61520 · Fulton County
Emergency services Birthing friendly

St Mary Medical Center

Acute Care Hospitals · Galesburg, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number140064
Location3333 North SeminaryGalesburg, IL 61401 · Knox County
Emergency services Birthing friendly

Saint Francis Medical Center

Acute Care Hospitals · Peoria, IL
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140067
Location530 NE Glen Oak AvePeoria, IL 61637 · Peoria County
Emergency services Birthing friendly

Osf Saint Elizabeth Mdl Ctr

Acute Care Hospitals · Ottawa, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140110
Location1100 E Norris DriveOttawa, IL 61350 · La Salle County
Emergency services Birthing friendly

Osf Saint Clare Medical Center

Critical Access Hospitals · Princeton, IL
OwnershipGovernment - Local
CMS Certification Number141337
Location530 Park Avenue EastPrinceton, IL 61356 · Bureau County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61801 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
$127.46 typical visit price
range $54.80 – $168.44
Typical copayment $31.86 (range $13.70 – $42.11)
Most-billed visit code 99204
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

DR. UDAY BHASKAR KANAKADANDI MD
Internal Medicine (Interventional Cardiology)
611 W PARK ST, HVI
URBANA, IL 61801
Champaign County (217) 383-3110
DR. VIKAS DESAI MD
Urology
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 383-3160
ANUJA BEDI D.O, M.P.H
Family Medicine
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 383-3311
EMILY REMINGTON NP
Nurse Practitioner (Women's Health)
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 383-3140
MAHMOUD ELRAKHAWY MD
Surgery (Vascular Surgery)
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 904-7000
KENDALL E WALLACE APRN
Nurse Practitioner (Family)
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 383-3311
ANNE FAHNESTOCK PT
Physical Therapist
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 383-3311
TIMTIM APPERSON APRN
Family Medicine
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 954-2805

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 Kelly Roth's NPI number?

The NPI number for Kelly Roth is 1346892270. It was assigned to this individual provider in the NPPES registry on July 11, 2019.

Where is Kelly Roth located?

Kelly Roth practices at 611 W Park St, Urbana, IL 61801. The listed phone number is (217) 383-4633.

What is Kelly Roth's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Kelly Roth enrolled in Medicare?

Yes. Kelly 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 Kelly Roth affiliated with any hospitals?

According to CMS data, Kelly Roth is affiliated with Graham Hospital Association, St Mary Medical Center, Saint Francis Medical Center, Osf Saint Elizabeth Mdl Ctr and Osf Saint Clare Medical Center.

When was this NPI record last updated?

The NPPES record for Kelly Roth was last updated on June 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.