Edmund J Roache, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

153941 Issued in NY

Practice address

200 Mullin St
Watertown, NY 13601-3619

Phone

(315) 785-8591

Fax

(315) 782-4475

NPI assigned

May 17, 2006

Last updated

Aug 3, 2015By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal MedicineAlso: Family Practice

Education

New York Medical College, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellness Physician Care PLLCGroup PAC ID 3971514365, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellness Physician Care PLLC

  dba QuikMed Urgent Care

  • Internal Medicine Physician
  • Watertown, NY
  • NPI 1114979598
  Medicare reassignment Care Compare group NPD Authorized official
• Edmund J Roache MD

  • Internal Medicine Physician
  • Watertown, NY
  • NPI 1245265321
  NPD (past) Authorized official
• Edmund Joseph Roache, M.D.

  • Internal Medicine Physician
  • Watertown, NY
  • NPI 1669424602
  NPD (past) Authorized official

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438560000000",
    "number": "1780636704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MULLIN ST",
            "address_2": "#102",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136013619",
            "telephone_number": "315-782-4475",
            "fax_number": "315-785-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MULLIN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136013619",
            "telephone_number": "315-785-8591",
            "fax_number": "315-782-4475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACHE",
        "first_name": "EDMUND",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2015-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "153941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00772743",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rite Aid of New York Inc (Rite Aid Pharmacy 02294)
• Rite Aid of New York Inc (Rite Aid Pharmacy 04681)
• Natalie Rivellli, MHC
• Julie Rivera
• Kaleigh Anne Riverso, RN
• Taylor Cliffe Robertson, DDS
• Cortney Rae Robinson, PHARMD
• Jody Rocha, LMSW
• Emma Rockwood
• Jessica Rodrigues, LMT

• Internal Medicine Physician in Watertown, NY
• Providers in Watertown, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; 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.