Active NPI
Kierra La Shawn Bruno-Rodgers
- Surgical Technologist
- Chicago, IL
National Provider Identifier
1073080909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- Practice address
- 712 N Dearborn St
Chicago, IL 60654-3846 - Phone
- (708) 692-0728
- NPI assigned
- Oct 29, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | Primary | ||
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 238000612 | IL |
Addresses
Primary practice location
712 N Dearborn St
Chicago, IL 60654-3846
Mailing address
420 Winston LN
Chicago Heights, IL 60411-1620
Phone (708) 692-0728
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 238000612 | Other | IL | REGISTERED SURGICAL ASSISTANT |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238000612 | IL | MD | Sports Medicine (Orthopaedic Surgery) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540857600000",
"number": "1073080909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 WINSTON LN",
"city": "CHICAGO HEIGHTS",
"state": "IL",
"postal_code": "604111620",
"telephone_number": "708-692-0728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 N DEARBORN ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606543846",
"telephone_number": "708-692-0728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNO-RODGERS",
"first_name": "KIERRA",
"middle_name": "LA SHAWN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-29",
"last_updated": "2018-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": null,
"license": null,
"primary": true
},
{
"code": "207XX0005X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Sports Medicine",
"state": "IL",
"license": "238000612",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTERED SURGICAL ASSISTANT",
"identifier": "238000612",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.