Look up the most recent NPI and PECOS records

Bryan Gary James Roth

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

PECOS Enrollment

This provider is enrolled in PECOS as BRYAN ROTH.

Based on the most recent information from CMS, provider Bryan Gary James Roth is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1750050001
Provider Type
Individual
Full Name
Roth, Bryan Gary James
Gender
Male

Sole Proprietor
No
Enumeration Date
9/9/2021
Last Updated
5/27/2025

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 494-1775

(503) 494-4749

Mailing Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 494-1775

(503) 494-4749

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA207736 Oregon
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA207736 Oregon

Bryan Gary James Roth

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Ballard, Cody Lee

Merz, Stacey Marie

Praytor, Jordan Elizabeth

Fix, Paxton

Tartaglia, Ryan T

Fay, Shannon

Wood, Ann Margaret

Kuzma, Laura

Early, Jocelyn M

Myers, Robert A