Anthony Roach, PC-IT, SW

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1281-226 Issued in WI

Practice address

3900 W Brown Deer Rd
Ste 200
Brown Deer, WI 53209-1220

Phone

(414) 540-2170

Fax

(414) 540-2171

NPI assigned

Nov 9, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shorehaven Behavioral Health Inc

  • Child & Adolescent Psychiatry Physician
  • Milwaukee, WI
  • NPI 1598800740
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352419200000",
    "number": "1083968200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 W BROWN DEER RD",
            "address_2": "STE 200",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091220",
            "telephone_number": "414-540-2170",
            "fax_number": "414-540-2171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 W BROWN DEER RD",
            "address_2": "STE 200",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091220",
            "telephone_number": "414-540-2170",
            "fax_number": "414-540-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "ANTHONY",
        "credential": "PC-IT, SW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-11-09",
        "last_updated": "2012-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "1281-226",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "7196-120",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol M Retzer, LPN
• Matthew M Richlen, MD
• Nicole M. Rintelman, MSN, PMHNP-BC
• Gladys Rivera, RN
• RN Private Care LLC
• Kenya Roberson, APSW
• Breanna Robinson
• Markena Robinson
• Robynn'S Gifted Hands of Love LLC
• Pedro Rojo Segura, RDH

• Professional Counselor in Brown Deer, WI
• Providers in Brown Deer, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.