Individual provider Active NPI

Jody Ann Roach, NP

  • Gerontology Nurse Practitioner
  • Coshocton, OH
National Provider Identifier
1467976993
Registry record updated Dec 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APRN.CNP021356 Issued in OH
Practice address
100 S Whitewoman St
Coshocton, OH 43812-1068
Phone
(740) 622-1220
Fax
(740) 622-6384
NPI assigned
Jul 26, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN.CNP021356 OH Primary

Addresses

Primary practice location

100 S Whitewoman St
Coshocton, OH 43812-1068

Mailing address

12201 Bluegrass Pkwy
Louisville, KY 40299-2361
Phone (502) 568-7364

Other practice location 1

2951 Maple Ave
Zanesville, OH 43701-1406
Phone (740) 454-5759

Other identifiers 2

IdentifierTypeStateIssuer
0236769MedicaidOH
H605201OtherOHMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20170912002599 OH Practitioner - Nurse Practitioner 9234402322 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Genesis Medical Group, LLCGroup PAC ID 7719040385, 265 clinicians

Practice addresses (Care Compare)

955 Bethesda Dr
FL 1
Zanesville, OH 43701-1873
Phone (740) 454-0804

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN.CNP021356OHMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Medical Group, LLC CurrentSince Aug 6, 2017 Accepting new patients
Genesis Medical Group LLC CurrentSince Aug 6, 2017 Accepting new patients
Central Ohio Hospitalists, Inc CurrentSince Jan 28, 2020 Accepting new patients

Locations

3535 Olentangy River Rd
Columbus, OH 43214
Phone (614) 566-1997

100 S Whitewoman St
Coshocton, OH 43812
Phone (740) 622-1220

646 Chestnut St
Coshocton, OH 43812
Phone (740) 622-3370

48439 Genesis Dr
Ste F
Coshocton, OH 43812
Phone (740) 623-4481

301 Mike Clouse Dr
#2A
Somerset, OH 43783
Phone (740) 836-0035

1246 Ashland Ave
Ste 204
Zanesville, OH 43701
Phone (740) 450-6167

999 Garden Rd
Zanesville, OH 43701
Phone (740) 454-8193

945 Bethesda Dr
Ste 200
Zanesville, OH 43701
Phone (740) 454-4788

955 Bethesda Dr
Fl 1
Zanesville, OH 43701
Phone (740) 454-0804

2951 Maple Ave
Zanesville, OH 43701
Phone (740) 454-4000

945 Bethesda Dr
Ste 330
Zanesville, OH 43701
Phone (740) 454-4038

2800 Maple Ave
Ste A
Zanesville, OH 43701
Phone (740) 454-4200

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1501027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544140800000",
    "number": "1467976993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12201 BLUEGRASS PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402992361",
            "telephone_number": "502-568-7364",
            "fax_number": "502-568-7136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S WHITEWOMAN ST",
            "city": "COSHOCTON",
            "state": "OH",
            "postal_code": "438121068",
            "telephone_number": "740-622-1220",
            "fax_number": "740-622-6384"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2951 Maple Ave",
            "address_purpose": "LOCATION",
            "city": "Zanesville",
            "state": "OH",
            "postal_code": "437011406",
            "country_code": "US",
            "telephone_number": "740-454-5759",
            "fax_number": "740-455-7632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROACH",
        "first_name": "JODY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-26",
        "last_updated": "2018-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP021356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0236769",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H605201",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coshocton, OH

Sources for this page

Verify at the official NPI Registry.