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Active NPI 1629940465 Individual Practitioner Female Practitioner

Samantha Jo Roach , FNP-C

Nurse Practitioner - Family • Canton, IL

Professional Overview & Biography Verified Profile Summary

Samantha Roach, FNP-C is a certified Nurse Practitioner - Family practicing in Canton, IL. With approximately 1 years of clinical experience since completing medical education in 2025, Samantha Roach delivers high-quality medical care to the local community at 210 W WALNUT ST.

Samantha Roach does not directly accept Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

210 W Walnut St

Canton, IL 615202444

Telephone 3096475240
Associated Practice Facility / Clinic
🏢 Jae Kim, M.d. Facility NPI 1710928627

Medicare Profile & Education

Medical School

Other

Graduation Year

2025

Medicare Assignment

Not Specified

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner - Family in Canton, IL

Rising Specialist (<5 Yrs)
Practitioner Clinical Experience
1 Yrs -3.5 yrs vs City Avg
City Avg: 4.5 Yrs
State Avg: 8.9 Yrs
Regional Practice Density
14 Specialists

Practicing in Canton, IL (7705 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Roach (1 Years) 1 Yrs
Canton Specialty Average (4.5 Years) 4.5 Yrs

Medical Specialties & State Licenses

CMS Verified: 2025-09-17
Nurse Practitioner - Family Primary Specialty

NUCC Taxonomy Code: 363LF0000X

State License IL 209033247

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

25 Associated Practitioners
Della Eeten , CRNA

Nurse Anesthetist, Certified Registered

NPI 1003013038

Certified Registered Nurse Anesthetist

Gerri Delost , CRNA

Nurse Anesthetist, Certified Registered

NPI 1053480707

Certified Registered Nurse Anesthetist

Courtney Inness

Nurse Practitioner - Family

NPI 1073311403
Lorna Eaton

Physical Therapy Assistant

NPI 1154296119
Christina Willey , OT

Occupational Therapist

NPI 1235699893

Occupational Therapist

Dr. Ronald Champagne , MD

Pathology - Anatomic Pathology & Clinical Pathology

NPI 1306884622

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active September 22, 2025

NPI status registered as active in NPPES database

📍
Updated Practice Location September 22, 2025

Registered at 210 W WALNUT ST, CANTON, IL 615202444 (Tel: 3096475240)

📍
Updated Business Mailing Address September 22, 2025

Registered at 3994 N FISK RD, ASTORIA, IL 615018750 (Tel: 3093572004)

👤
Provider Name / Credentials Updated September 22, 2025

Recorded as SAMANTHA ROACH, FNP-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 22, 2025

Nurse Practitioner (License #209033247 in IL)

🟢
Initial NPI Registration & Enumeration September 22, 2025

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1629940465
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 22, 2025
Last Update: September 22, 2025
Sole Proprietor: No

Mailing Address

3994 N Fisk Rd

Astoria, IL 615018750

Phone: 3093572004

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.