Samantha Jo Roach, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209033247 Issued in IL

Practice address

210 W Walnut St
Canton, IL 61520-2444

Phone

(309) 647-5240

NPI assigned

Sep 22, 2025

Sex

Female

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

Not listed in the public Medicare enrollment file

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.

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Graham Hospital AssociationGroup PAC ID 2769375021, shared by 15 NPIs, 124 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1758499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1629940465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3994 N FISK RD",
            "city": "ASTORIA",
            "state": "IL",
            "postal_code": "615018750",
            "telephone_number": "309-357-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W WALNUT ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202444",
            "telephone_number": "309-647-5240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "SAMANTHA",
        "middle_name": "JO",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-22",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209033247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Barry Renick, MD
• Robert Koert Rennecker, BS
• Courtney Meghann Reynolds, APN
• Rebekah J Ridgeway, CFNP
• River Valley Speech Associates, LTD.
• Cassy Roat-Rhinehart, OD
• Elizabeth Ann Rockwell
• Jake Ruff, D.P.M.
• Michael J Sammarco, MD
• Amy Sammis, R.D., L.D.N.

• Family Nurse Practitioner in Canton, IL
• Providers in Canton, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; 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.