NPIMap

Individual provider Active NPI

Justin T Roach, APRN, NP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Emporia, KS
National Provider Identifier
1851950364
Registry record updated Sep 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
78756 Issued in KS
Practice address
1301 W 12TH Ave
Emporia, KS 66801-2587
Phone
(620) 343-2376
Fax
(620) 343-5987
NPI assigned
Jun 8, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 53-78756-082 KS
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 78756 KS Primary

Addresses

Primary practice location

1301 W 12TH Ave
Emporia, KS 66801-2587

Mailing address

1201 W 12TH Ave
Emporia, KS 66801-2504
Phone (620) 343-2376

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190812001178 KS Practitioner - Nurse Practitioner 1153658364 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Newman Memorial County HospitalGroup PAC ID 5193638526, shared by 6 NPIs, 61 clinicians

Practice addresses (Care Compare)

1301 W 12TH Ave
Emporia, KS 66801-2590

1301 W 12TH Ave 301 and
205 NRH Medical Partners Primary Care
Emporia, KS 66801-2590
Phone (620) 343-2376

Hospital & facility affiliations

  • Neosho Memorial Regional Medical Center Hospital, Chanute, KS, CCN 171380
  • Newman Regional Health Hospital, Emporia, KS, CCN 171384
  • Allen County Regional Hospital Hospital, Iola, KS, CCN 171373

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53-78756-082KSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Kansas Mental Health Center Family CurrentSince Apr 22, 2024 Accepting new patients
Building Health Inc. CurrentSince Jul 1, 2020 Accepting new patients
Williams Medical Group Practice, LLC CurrentSince Jul 1, 2023 Accepting new patients
Williams Medical Group Practice, LLC CurrentSince Jul 1, 2023 Accepting new patients
Pawnee Mental Health Service, Inc. Past Accepting new patients

Locations

231 S Andover Rd
Andover, KS 67002
Phone (316) 733-9355

505 S Plummer Ave
Chanute, KS 66720

2031 W 6th Ave
Emporia, KS 66801
Phone (620) 481-2520

1624 S National Ave
Fort Scott, KS 66701
Phone (620) 223-5000

1106 S 9th St
Humboldt, KS 66748
Phone (620) 473-2241

2051 N State St
Iola, KS 66749
Phone (620) 380-6400

3015 N Michigan St
Pittsburg, KS 66762
Phone (620) 240-5615

3011 N Michigan St
Pittsburg, KS 66762
Phone (620) 231-1960

204 S Main St
Yates Center, KS 66783
Phone (620) 625-2162

Interoperability endpoints

  • Direct secure messaging: justin.roach.1@24081.direct.athenahealth.com

Organizations & group practices 7

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 6

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": "1559952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1851950364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 W 12TH AVE",
            "city": "EMPORIA",
            "state": "KS",
            "postal_code": "668012504",
            "telephone_number": "620-343-2376",
            "fax_number": "620-343-5987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 W 12TH AVE",
            "city": "EMPORIA",
            "state": "KS",
            "postal_code": "668012587",
            "telephone_number": "620-343-2376",
            "fax_number": "620-343-5987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "JUSTIN",
        "middle_name": "T",
        "credential": "APRN, NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-08",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-78756-082",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KS",
            "license": "78756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Emporia, KS

Sources for this page

Verify at the official NPI Registry.