Michael Stephen Roach, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA55818 Issued in CA

Practice address

Nmrtc Camp Pendleton
4TH Floor, RM 4172
Camp Pendleton, CA 92055

Phone

(760) 725-1288

NPI assigned

May 21, 2007

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 CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Regents of the University of California

  • Emergency Medicine Physician
  • San Diego, CA
  • NPI 1780870899
  Medicare reassignment NPD
• Regents of the Unviersity of California

  • Emergency Medicine Physician
  • La Jolla, CA
  • NPI 1629095500
  NPD
• Regents of the University of California

  • Pharmacy
  • San Diego, CA
  • NPI 1598786576
  NPD (past)
• Regents of the University of California Ucsd Head and Neck Surgery

  • Otolaryngology Physician
  • San Diego, CA
  • NPI 1679509962
  NPD (past)

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1326256447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NMRTC CAMP PENDLETON",
            "address_2": "4TH FLOOR, RM 4172",
            "city": "CAMP PENDLETON",
            "state": "CA",
            "postal_code": "92055",
            "telephone_number": "760-725-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NMRTC CAMP PENDLETON",
            "address_2": "4TH FLOOR, RM 4172",
            "city": "CAMP PENDLETON",
            "state": "CA",
            "postal_code": "92055",
            "telephone_number": "760-725-1288"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Naval Medical Center San Diego 34800 Bob Wilson Drive",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921340001",
            "country_code": "US",
            "telephone_number": "619-532-6462",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "US NAVAL HOSPITAL OKINAWA",
            "address_2": "Psc 482",
            "address_purpose": "LOCATION",
            "city": "FPO",
            "state": "AP",
            "postal_code": "963621600",
            "country_code": "US",
            "telephone_number": "01181989717555",
            "country_name": "United States",
            "address_type": "MIL"
        }
    ],
    "basic": {
        "last_name": "ROACH",
        "first_name": "MICHAEL",
        "middle_name": "STEPHEN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA55818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Richards, M.D.
• Sharita J Richards, RN
• John William Richman, IDC
• Mark Riebel, DPT
• Rebecca M Rieger, MD
• Richard Kevin Roach, DO
• Anne Bryant Roberts, M.D.
• Evan Matthew Roberts, O.D.
• William Lincoln Roberts, M.D.
• James Robertson, IDC

• Physician Assistant in Camp Pendleton, CA
• Providers in Camp Pendleton, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; 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.