Active NPI 1477743813 Individual Practitioner Female Practitioner

Michelle L Roth , PA

Physician Assistant • Peoria, IL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Michelle Roth, PA is a certified Physician Assistant practicing in Peoria, IL. With approximately 19 years of clinical experience since completing medical education in 2007, Michelle Roth delivers high-quality medical care to the local community at 4909 N GLEN PARK PLACE RD.

Michelle Roth is affiliated with Soderstrom Dermatology Center S C and accepts Medicare assignment.

Frequently performed procedures and clinical services include injection, tildrakizumab, 1 mg, destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

4909 N Glen Park Place Rd

Peoria, IL 616144676

Telephone 3096747546

Fax 3092820500

Associated Practice Facility / Clinic

🏢 Soderstrom Dermatology Center S C Facility NPI 1053362343

Medicare Profile & Education

Medical School

Other

Graduation Year

2007

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Peoria, IL

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

19 Yrs +6.9 yrs vs City Avg

City Avg: 12.1 Yrs

State Avg: 11.7 Yrs

Regional Practice Density

96 Specialists

Practicing in Peoria, IL (4958 Statewide)

Telehealth Adoption Rate

10.4% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

66.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Roth (19 Years) 19 Yrs

Peoria Specialty Average (12.1 Years) 12.1 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3245 Injection, tildrakizumab, 1 mg	2,400	13	$160.00	$133.81
17003 Destruction of precancer skin growth, 2-14 growths	1,857	338	$55.00	$5.18
99213 Established patient office or other outpatient visit, typically 15 minutes	1,431	1,054	$150.00	$73.80
95044 Test for allergy using skin patch	1,360	17	$15.00	$3.94
17000 Destruction of skin growth	608	466	$185.00	$46.55
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	285	185	$200.00	$104.33
11102 Tangential biopsy of single skin lesion	282	247	$262.62	$75.43
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	220	26	$265.00	$90.79
17110 Destruction of up to 14 skin growths	167	143	$250.00	$86.25
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	103	14	$425.00	$122.11
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	73	55	$35.00	$11.47
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	59	44	$22.49	$0.98
11103 Biopsy of related skin growth, each additional growth	54	44	$190.00	$39.87
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	52	52	$215.00	$91.34
17004 Destruction of precancer skin growth, 15 or more growths	38	30	$525.00	$133.54
10040 Acne surgery	23	20	$265.00	$92.45
11104 Punch biopsy, first skin growth	21	21	$375.00	$98.70
11200 Removal of skin tag, 1-15 skin tags	18	18	$208.89	$59.76
36415 Insertion of needle into vein for collection of blood sample	13	11	$12.31	$8.65

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3245 Injection, tildrakizumab, 1 mg	2,600	14	$160.00	$138.33
17003 Destruction of precancer skin growth, 2-14 growths	1,862	337	$13.77	$5.37
99213 Established patient office or other outpatient visit, typically 15 minutes	1,570	1,028	$91.29	$74.67
95044 Test for allergy using skin patch	1,520	19	$5.21	$4.06
17000 Destruction of skin growth	635	455	$76.60	$48.75
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	273	33	$122.10	$93.16
11102 Tangential biopsy of single skin lesion	241	222	$158.56	$77.73
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	190	116	$130.60	$106.13
17110 Destruction of up to 14 skin growths	148	127	$138.87	$89.91
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	136	12	$178.55	$126.31
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	90	63	$24.45	$11.47
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	71	51	$21.22	$1.04
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	58	58	$116.47	$93.50
11103 Biopsy of related skin growth, each additional growth	51	41	$57.33	$41.15
17004 Destruction of precancer skin growth, 15 or more growths	27	22	$164.06	$138.77
11200 Removal of skin tag, 1-15 skin tags	23	22	$89.30	$62.19
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	22	22	$55.60	$46.66
11104 Punch biopsy, first skin growth	20	19	$139.38	$102.70
10040 Acne surgery	11	11	$115.88	$95.25

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,501	979	$90.05	$74.50
17003 Destruction of precancer skin growth, 2-14 growths	1,435	304	$12.09	$5.38
17000 Destruction of skin growth	512	403	$72.11	$46.49
11102 Tangential biopsy of single skin lesion	218	191	$156.44	$77.62
17110 Destruction of up to 14 skin growths	206	182	$111.54	$89.54
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	145	116	$130.57	$104.38
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	57	57	$112.97	$92.50
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	54	31	$115.89	$92.82
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	48	35	$20.89	$1.09
11103 Biopsy of related skin growth, each additional growth	47	40	$54.46	$41.54
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	42	30	$24.05	$11.10
11200 Removal of skin tag, 1-15 skin tags	32	32	$89.30	$56.41
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	30	11	$161.08	$127.11
17004 Destruction of precancer skin growth, 15 or more growths	25	21	$163.34	$137.28
10040 Acne surgery	16	15	$115.67	$94.35
69100 Biopsy of ear	13	11	$98.46	$70.17
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	13	11	$150.89	$85.27
11104 Punch biopsy, first skin growth	12	12	$126.96	$103.02
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	11	11	$106.89	$68.19
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	11	11	$55.60	$46.06

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,431	260	$11.32	$5.24
99213 Established patient office or other outpatient visit, typically 15 minutes	1,364	831	$85.58	$75.66
17000 Destruction of skin growth	457	346	$71.95	$45.75
17110 Destruction of up to 14 skin growths	172	148	$110.61	$88.56
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	155	128	$118.83	$107.83
11102 Tangential biopsy of single skin lesion	125	120	$136.98	$77.70
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	69	55	$137.61	$92.64
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	65	31	$111.01	$93.18
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	59	45	$23.69	$11.64
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	53	40	$22.77	$1.27
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	40	40	$111.34	$93.11
11200 Removal of skin tag, 1-15 skin tags	39	37	$91.70	$56.05
17004 Destruction of precancer skin growth, 15 or more growths	32	28	$159.74	$135.95
11103 Biopsy of related skin growth, each additional growth	28	22	$54.46	$43.25
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	22	22	$147.35	$147.56
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	21	14	$161.08	$131.95
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	19	17	$138.98	$109.68
36415 Insertion of needle into vein for collection of blood sample	18	15	$5.00	$3.00
10040 Acne surgery	18	18	$113.06	$87.93
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	16	16	$119.50	$94.30
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	14	14	$105.79	$57.10
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	13	13	$139.23	$103.13
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	12	12	$51.43	$46.19
11104 Punch biopsy, first skin growth	11	11	$126.96	$106.40

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	945	188	$9.74	$4.89
99213 Established patient office or other outpatient visit, typically 15 minutes	893	541	$74.85	$62.51
17000 Destruction of skin growth	337	248	$73.35	$46.71
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	229	199	$147.71	$121.68
17110 Destruction of up to 14 skin growths	93	79	$110.74	$88.19
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	87	78	$109.51	$90.53
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	62	42	$21.07	$1.44
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	54	37	$22.25	$11.81
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	51	41	$120.10	$92.62
11102 Tangential biopsy of single skin lesion	42	42	$108.31	$76.50
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	40	27	$101.36	$86.79
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	22	22	$112.56	$91.38
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	22	22	$132.10	$106.50
11200 Removal of skin tag, 1-15 skin tags	18	17	$98.03	$51.70
17004 Destruction of precancer skin growth, 15 or more growths	16	15	$153.32	$131.02
11104 Punch biopsy, first skin growth	14	14	$126.96	$103.63
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	14	14	$113.75	$88.89
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	12	11	$138.18	$111.70
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	12	11	$43.72	$37.66
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	12	12	$119.48	$97.88
11103 Biopsy of related skin growth, each additional growth	12	11	$65.95	$43.73
36415 Insertion of needle into vein for collection of blood sample	11	11	$5.00	$2.98

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	945	589	$70.98	$60.95
17003 Destruction of precancer skin growth, 2-14 growths	861	180	$10.03	$4.57
17000 Destruction of skin growth	336	246	$73.68	$47.88
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	190	162	$140.68	$120.58
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	143	123	$106.54	$88.00
17110 Destruction of up to 14 skin growths	98	89	$104.36	$86.39
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	80	49	$68.39	$67.07
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	68	51	$20.43	$1.59
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	56	44	$23.74	$13.60
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	54	47	$117.03	$86.43
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	32	24	$41.84	$36.68
11102 Tangential biopsy of single skin lesion	29	29	$100.99	$78.47
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	22	16	$151.46	$131.61
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	15	15	$123.93	$82.21
11200 Removal of skin tag, 1-15 skin tags	13	13	$84.30	$58.45
11104 Punch biopsy, first skin growth	12	12	$126.96	$100.66

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,173	222	$9.51	$4.32
99213 Established patient office or other outpatient visit, typically 15 minutes	1,006	627	$71.45	$59.37
17000 Destruction of skin growth	394	295	$72.03	$49.14
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	184	163	$139.90	$120.06
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	153	124	$105.97	$87.96
17110 Destruction of up to 14 skin growths	80	73	$106.15	$85.72
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	62	45	$20.44	$1.75
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	55	41	$23.74	$16.04
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	50	45	$111.91	$88.84
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	33	31	$109.96	$76.30
11100 Biopsy of single growth of skin and/or tissue	30	29	$103.53	$82.81
11200 Removal of skin tag, 1-15 skin tags	27	24	$84.30	$68.19
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	24	19	$71.11	$68.36
17004 Destruction of precancer skin growth, 15 or more growths	21	15	$142.88	$118.95
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	18	18	$106.38	$87.61
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	14	14	$104.77	$88.71
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	13	12	$41.84	$35.41
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	12	12	$114.39	$99.69

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,515	289	$10.34	$4.54
99213 Established patient office or other outpatient visit, typically 15 minutes	1,195	712	$71.31	$59.51
17000 Destruction of skin growth	494	358	$73.17	$48.62
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	229	201	$140.66	$118.58
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	134	114	$105.73	$88.11
17110 Destruction of up to 14 skin growths	87	79	$102.71	$85.61
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	72	38	$67.56	$54.91
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	63	39	$22.17	$1.74
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	61	38	$23.60	$19.99
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	43	42	$111.91	$93.91
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	43	42	$106.38	$88.80
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	41	37	$105.82	$78.38
11200 Removal of skin tag, 1-15 skin tags	37	34	$90.32	$63.23
11100 Biopsy of single growth of skin and/or tissue	30	27	$97.29	$80.35
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	25	22	$93.27	$66.08
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	24	24	$111.70	$86.91
17004 Destruction of precancer skin growth, 15 or more growths	21	18	$142.88	$122.75
36415 Insertion of needle into vein for collection of blood sample	20	19	$5.00	$2.94
96921 Treatment of inflammatory skin disease using laser, 250.0-500.0 sq cm	18	11	$166.87	$136.08
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	13	13	$41.84	$35.22

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Hospital & Practice Group Affiliations

Soderstrom Dermatology Center S C

1800 E 54th St, Davenport, IA 528072852

Phone: 5633447546

Soderstrom Dermatology Center S C

4909 N Glen Park Place Rd, Peoria, IL 616144676

Phone: 3096747546

Soderstrom Dermatology Center S C

60 S Soangetaha Rd, Galesburg, IL 614017524

Phone: 3093445777

Soderstrom Dermatology Center S C

1302 7th St, Moline, IL 612652900

Phone: 3092770772

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

14 Associated Practitioners

Madeline Taylor

Nurse Practitioner - Family

NPI 1033079355

Dr. Carl Soderstrom , MD

Dermatology - Dermatopathology

NPI 1053370759

Doctor of Medicine (M.D.)

Dr. James Jeffries , MD

Surgery - Plastic and Reconstructive Surgery

NPI 1073655676

Doctor of Medicine (M.D.)

Stuart Berryman , PA-C

Physician Assistant - Medical

NPI 1093774705

Physician Assistant (Certified)

Jordyn Lewandowski , APRN

Nurse Practitioner - Family

NPI 1144892175

Advanced Practice Registered Nurse

Dr. Tesfu Hailu , MD

Dermatology - Dermatopathology

NPI 1245490382

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active August 01, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location August 01, 2007

Registered at 4909 N GLEN PARK PLACE RD, PEORIA, IL 616144676 (Tel: 3096747546)

📍

Updated Business Mailing Address August 01, 2007

Registered at 4909 N GLEN PARK PLACE RD, PEORIA, IL 616144676 (Tel: 3096747546)

👤

Provider Name / Credentials Updated August 01, 2007

Recorded as MICHELLE ROTH, PA

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 01, 2007

Physician Assistant

🟢

Initial NPI Registration & Enumeration August 01, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews

No patient reviews submitted yet for Michelle Roth. Be the first to share your experience!

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1477743813

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: August 01, 2007

Last Update: August 01, 2007

Sole Proprietor: No

Update or Correct Profile

Mailing Address

4909 N Glen Park Place Rd

Peoria, IL 616144676

Phone: 3096747546

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.