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

Lucas B Roth, PA-C

Individual provider Physician Assistant · NPI 1083124846

Lucas B Roth, PA-C is a Physician Assistant in Peoria, Illinois. Qualified in 2017, 9 years ago. Practices with Select Rehabilitation, LLC, a 2,028-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
9
Licensed in
IL
In the registry since
2017
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

6000 N Allen Rd
Peoria, IL 61614-3294
Phone: (309) 691-1400
Fax: (309) 693-3197
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 085006385 (IL)
Physician Assistant Taxonomy 363A00000X · Licence 085006385 (IL)

Record details

NPI number1083124846
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 6, 2017
Last updated in NPPESJune 19, 2025
Certification dateJune 19, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Select Rehabilitation, Llc — 2028 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Peoria