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JOHNATHAN SHANE ROACH
NPI 1124755715
Counselor - Professional in Arkadelphia, AR

Active since August 03, 2022PECOS Enrolled
2607 CADDO ST STE 6, ARKADELPHIA, AR 71923(870) 230-8217 Get Directions Write a Review

NPPES record last updated: July 22, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Johnathan Shane Roach NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JOHNATHAN SHANE ROACH (NPI 1124755715) is an individual professional provider in Arkadelphia, Arkansas, licensed in Arkansas (P2507012) and active in the NPI registry since August 2022. He is enrolled in Medicare PECOS, maintains a secondary practice location in Murfreesboro, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1124755715
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameJOHNATHAN SHANE ROACH
Location Address2607 CADDO ST STE 6Arkadelphia, AR 71923-5307
Mailing Address10311 W Markham StLittle Rock, AR 72205-2135 · (870) 340-2636 · Fax (888) 816-7916
Phone(870) 230-8217
Sole ProprietorYes
Medical School CMSOtherGraduated 2022
Enumeration DateAugust 3, 2022
Last NPPES UpdateJuly 22, 2025
NPPES CertifiedJuly 22, 2025
✔ NPI 1124755715 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
Licenses✔ Licensed in AR · P2507012✔ Licensed in TX · 91413
Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X
2607 CADDO ST STE 6, Arkadelphia, AR 71923
Open in Google Maps ↗

Secondary Practice Location 1

Location 1321 E 13th StMurfreesboro, AR 71958-9541 · Phone (870) 285-3699

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Arkansas Blue Cross and Blue Shield, Blue Cross and Blue Shield of Texas, Health Advantage and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Johnathan Shane Roach is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2769940998
PECOS Enrollment IDI20260818005200
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Johnathan Roach reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Chenal Family Therapy, Plc
59 mi
Mental Health
10311 W MARKHAM ST
Little Rock, AR 72205
  • Reassigned Medicare billing, Arkansas enrollment
  • 94 clinicians in this Medicare group
NPI 1356604219 (501) 781-2230

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. PEGGY BURT LAC
Counselor (Professional)
2607 CADDO ST STE 6, AR COUNSELING & PSYCHODIAGNOSTICS, INC.
ARKADELPHIA, AR 71923
Clark County (870) 230-8217
PERRY N. SMITH
Case Manager/Care Coordinator
2607 CADDO ST STE 6
ARKADELPHIA, AR 71923
Clark County (870) 230-8217
ARIANNA LEEPER
Case Manager/Care Coordinator
2607 CADDO ST STE 6
ARKADELPHIA, AR 71923
Clark County (870) 230-8217
JENNIFER BURKS
Case Manager/Care Coordinator
2607 CADDO ST STE 6
ARKADELPHIA, AR 71923
Clark County (870) 230-8217
NICHOLAS WYATT
Case Manager/Care Coordinator
2607 CADDO ST STE 6
ARKADELPHIA, AR 71923
Clark County (870) 230-8217
MISTY GAIL KIMBERLIN
Counselor (Mental Health)
2607 CADDO ST STE 6
ARKADELPHIA, AR 71923
Clark County (870) 230-8217
KELLI COX
Case Manager/Care Coordinator
2607 CADDO ST STE 6
ARKADELPHIA, AR 71923
Clark County (870) 230-8217
HALEY M. LEE
Registered Nurse (Case Management)
2607 CADDO ST STE 6
ARKADELPHIA, AR 71923
Clark County (870) 230-8217

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Johnathan Roach's NPI number?

The NPI number for Johnathan Roach is 1124755715. It was assigned to this individual provider in the NPPES registry on August 3, 2022.

Where is Johnathan Roach located?

Johnathan Roach practices at 2607 Caddo St Ste 6, Arkadelphia, AR 71923. The listed phone number is (870) 230-8217.

What is Johnathan Roach's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Johnathan Roach enrolled in Medicare?

Yes. Johnathan Roach is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Johnathan Roach's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Johnathan Roach reassigns Medicare benefits to Chenal Family Therapy, Plc (Little Rock, AR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Johnathan Roach's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Johnathan Roach accept?

Health plans from Arkansas Blue Cross and Blue Shield, Blue Cross and Blue Shield of Texas, Health Advantage, Octave and UnitedHealthcare list Johnathan Roach as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Johnathan Roach was last updated on July 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.