Jason Roach, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.004474 Issued in IL

Practice address

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Phone

(309) 655-2036

NPI assigned

Oct 19, 2012

Last updated

Oct 19, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Group practices

Carle Eureka HospitalGroup PAC ID 3870914393, 10 clinicians

Carle West Physician Group IncGroup PAC ID 8921420308, 282 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carle Home Care Home health agency, Champaign, IL, CCN 147241
• Carle Eureka Hospital Hospital, Eureka, IL, CCN 141309
• Carle Bromenn Medical Center Hospital, Normal, IL, CCN 140127
• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
• Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jroachpa311088@carlehiedirect.net

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

• Carle Eureka Hospital

  dba Advocate Eureka Hospital

  • Critical Access Hospital
  • Eureka, IL
  • NPI 1184644023
  Medicare reassignment Care Compare group
• Carle West Physician Group Inc

  • Family Medicine Physician
  • Normal, IL
  • NPI 1467074138
  Medicare reassignment Care Compare group
• Carle Health Medical Group

  dba Carle Physician Group

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947
  Medicare reassignment NPD
• Carle Eureka Hospital

  dba Carle Eureka Family Medicine-El Paso

  • Rural Health Clinic/Center
  • El Paso, IL
  • NPI 1861919524
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Carle Bromenn Medical Center

  dba Advocate BroMenn Medical Center

  • General Acute Care Hospital
  • Normal, IL
  • NPI 1962424036
  Care Compare affiliation
• Carle Eureka Hospital

  dba Advocate Eureka Hospital

  • Critical Access Hospital
  • Eureka, IL
  • NPI 1184644023
  Care Compare affiliation
• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  Care Compare affiliation
• The Carle Foundation Hospital

  dba Carle Home Care

  • Home Health Agency
  • Champaign, IL
  • NPI 1891780615
  Care Compare affiliation

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

{
    "created_epoch": "1350604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350604800000",
    "number": "1104179795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 E GREENWOOD ST",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502572",
            "telephone_number": "815-674-0887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "JASON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-19",
        "last_updated": "2012-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.004474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Teri Rizzo, APN
• Patrick Joseph Rizzuto III, M.D.
• Steven Roat
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• Samantha Robbins, APN
• Robert J. Criss Reclamation Center (City Of Refuge Community Development Corporation)
• Robert M Quilleash OD PC

• Physician Assistant in Peoria, IL
• Providers in Peoria, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.