NPIMap

Individual provider Active NPI

Arthur Thomas Roach, P.A.-C.

  • Medical Physician Assistant
  • Horn Lake, MS
National Provider Identifier
1619967478
Registry record updated Nov 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-025 Issued in MS
Practice address
3040 Goodman Road, Suite C
Horn Lake, MS 38637-1189
Phone
(662) 280-3428
Fax
(662) 280-1736
NPI assigned
Oct 24, 2005
Last updated
Nov 20, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-025 MS Primary

Addresses

Primary practice location

3040 Goodman Road, Suite C
Horn Lake, MS 38637-1189

Mailing address

5185 Nail Road
Olive Branch, MS 38654-8245
Phone (662) 895-6738

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-025MSMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Nancy M. Birtley, LLC Past Accepting new patients
Jackson Madison County General Hospital Past Accepting new patients
Tennessee Em-I Medical Services, PC Past Accepting new patients
Southeastern Emergency Services P C Medical Past Accepting new patients
Tennessee Emergency Physicians, PLLC PastSince Feb 9, 2020 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258675200000",
    "number": "1619967478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5185 NAIL ROAD",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386548245",
            "telephone_number": "662-895-6738",
            "fax_number": "662-280-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 GOODMAN ROAD, SUITE C",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386371189",
            "telephone_number": "662-280-3428",
            "fax_number": "662-280-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "ARTHUR",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2009-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MS",
            "license": "PA-025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Horn Lake, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.