BRENNON ROTH
NPI 1881325116
Counselor - Professional in North Bend, OR

Q: What is Brennon Roth's NPI number?

The NPI number for Brennon Roth is 1881325116. It was assigned to this individual provider in the NPPES registry on June 17, 2022.

Q: What is Brennon Roth's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: Is Brennon Roth enrolled in Medicare?

No. Brennon Roth has opted out of Medicare through December 5, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Brennon Roth was last updated on August 1, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.

Active since June 17, 2022Opted out of Medicare · through Dec 5, 2027

1890 WAITE ST STE 1, NORTH BEND, OR 97459(541) 756-6232 Get Directions Write a Review

NPPES record last updated: August 1, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Brennon Roth NPPES

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

BRENNON ROTH (NPI 1881325116) is an individual professional provider in North Bend, Oregon, licensed in Oregon (C6849) and active in the NPI registry since June 2022. He has opted out of Medicare through December 5, 2027.

NPPES Registry Identity

NPI1881325116

Entity TypeIndividualMale

Primary Taxonomy101YP2500X

Provider Legal NameBRENNON ROTH

Location Address1890 WAITE ST STE 1North Bend, OR 97459-1229

Mailing Address1890 Waite St Ste 1North Bend, OR 97459-1229 · (541) 756-6232

Phone(541) 756-6232

Sole ProprietorNo

Enumeration DateJune 17, 2022

Last NPPES UpdateAugust 1, 2023

NPPES CertifiedAugust 1, 2023

✔ NPI 1881325116 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in OR · C6849

1890 WAITE ST STE 1, North Bend, OR 97459

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., PacificSource Health Plans and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Brennon Roth has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 5, 2025 through December 5, 2027.

Opt-Out Effective DateDecember 5, 2025

Opt-Out In Effect ThroughDecember 5, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

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.

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