Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bryan Gary James Roth

Individual provider Physician Assistant · NPI 1750050001

Bryan Gary James Roth is a Physician Assistant in Portland, Oregon. Qualified in 2021, 5 years ago. Practices with University Professional Services, a 1,704-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
5
Licensed in
OR
In the registry since
2021
Specialties on file
3
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Practice location Address checks out

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone: (503) 494-1775
Fax: (503) 494-4749
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1200 Ne 48th Ave Ste 1000, Hillsboro, OR 97124-5170 — (971) 470-3275

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA207736 (OR)
Physician Assistant Taxonomy 363A00000X
Physician Assistant Taxonomy 363A00000X · Licence PA207736 (OR)

Record details

NPI number1750050001
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 9, 2021
Last updated in NPPESMay 27, 2025
Certification dateMay 27, 2025
Mailing address3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice University Professional Services — 1704 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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