Active NPI
Blaine M Rogers
- Home Modifications Contractor
- Monona, WI
National Provider Identifier
1164074688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- 1031164
- Practice address
- 6200 Sylvan LN
Monona, WI 53716-3835 - Phone
- (608) 234-7440
- NPI assigned
- Jul 15, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 1031164 | WI | Primary |
Addresses
Primary practice location
6200 Sylvan LN
Monona, WI 53716-3835
Mailing address
6200 Sylvan LN
Monona, WI 53716-3835
Phone (608) 234-7440
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 |
|---|---|---|---|
| 1031164 | WI | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563148800000",
"number": "1164074688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6200 SYLVAN LN",
"city": "MONONA",
"state": "WI",
"postal_code": "537163835",
"telephone_number": "608-234-7440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6200 SYLVAN LN",
"city": "MONONA",
"state": "WI",
"postal_code": "537163835",
"telephone_number": "608-234-7440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROGERS",
"first_name": "BLAINE",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-07-15",
"last_updated": "2019-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "WI",
"license": "1031164",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monona, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.