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

Ted M. Roth, MD

Individual provider Obstetrics & Gynecology Physician · NPI 1174503866

Ted M. Roth, MD is an Obstetrics/Gynecology in South Bend, Indiana. Qualified in 1996, 30 years ago. Practices with State of Mississippi - University of Mississippi Medical Center, a 952-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
30
Licensed in
IN
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

621 Memorial Dr Ste 302
South Bend, IN 46601-1073
Phone: (574) 367-3800
Fax: (574) 367-3801
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 100 Navarre Pl Ste 4470, South Bend, IN 46601-1168 — (574) 367-3800

Specialties & licences

Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician (primary) Taxonomy 207VF0040X · Licence 01081226A (IN)
Obstetrics & Gynecology Physician Taxonomy 207V00000X · Licence 01081226A (IN)

Record details

NPI number1174503866
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJanuary 19, 2006
Last updated in NPPESJanuary 3, 2025
Certification dateJanuary 3, 2025
Mailing address1115 Burns St, South Bend, IN 46617-4403

Medicare enrollment

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

Medicare specialtyOBSTETRICS/GYNECOLOGY
Medical schoolOTHER
Graduated 1996 (30 years in practice)
Group practice State Of Mississippi - University Of Mississippi Medical Center — 952 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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