SAMANTHA JO ROACH FNP-C
NPI 1629940465
Nurse Practitioner - Family in Canton, IL

Q: What is Samantha Roach's NPI number?

The NPI number for Samantha Roach is 1629940465. It was assigned to this individual provider in the NPPES registry on September 22, 2025.

Q: What is Samantha Roach's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Samantha Roach was last updated on September 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.

Active since September 22, 2025PECOS Enrolled

210 W WALNUT ST, CANTON, IL 61520(309) 647-5240 Get Directions Write a Review

NPPES record last updated: September 22, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Samantha Jo Roach Fnp-c NPPES

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

SAMANTHA JO ROACH FNP-C (NPI 1629940465) is an individual family provider in Canton, Illinois, licensed in Illinois (209033247) and active in the NPI registry since September 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1629940465

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameSAMANTHA JO ROACHCredential: FNP-C

Location Address210 W WALNUT STCanton, IL 61520-2444

Mailing Address3994 N Fisk RdAstoria, IL 61501-8750 · (309) 357-2004

Phone(309) 647-5240

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateSeptember 22, 2025

NPPES CertifiedSeptember 17, 2025

✔ NPI 1629940465 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in IL · 209033247

210 W WALNUT ST, Canton, IL 61520

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samantha Jo Roach Fnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1658854468

PECOS Enrollment IDI20260310003801

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61520 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$97.25 typical visit price

range $17.16 – $136.56

Typical copayment $24.31 (range $4.29 – $34.14)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

DELLA EETEN CRNA

Nurse Anesthetist, Certified Registered