Active NPI
Rockford Urological Associates, LTD.
- Urology Physician
- Rockford, IL
National Provider Identifier
1194786558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- Legal business name
- ROCKFORD UROLOGICAL ASSOCIATES, LTD.
- Practice address
- 351 Executive Pkwy
Rockford, IL 61107-5339 - Phone
- (815) 398-4057
- Fax
- (815) 398-0220
- NPI assigned
- Mar 28, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jon Pick
- Title
- Coo
- Phone
- (815) 398-4057
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | IL | Primary |
Addresses
Primary practice location
351 Executive Pkwy
Rockford, IL 61107-5339
Mailing address
351 Executive Pkwy
Rockford, IL 61107-5339
Phone (815) 398-4057
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036058803 | Medicaid | IL | |
| 036099544 | Medicaid | IL | |
| 036066868 | Medicaid | IL | |
| 036080935 | Medicaid | IL | |
| 036067790 | Medicaid | IL | |
| 036051080 | Medicaid | IL | |
| 036054674 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0430238 | Rockford Urological Associates | Compliance | Oct 23, 2027 |
National Provider Directory
National Provider DirectoryLocations
215 E 1st St
Ste 105
Dixon, IL 61021
Phone (815) 285-5603
215 E 1st St
Dixon, IL 61021
Phone (815) 285-5591
Interoperability endpoints
- michaelfumo@rua.medalliesdirect.net
- erictaylor@rua.medalliesdirect.net
- liliaavila@rua.medalliesdirect.net
- courtneyeckhoff@rua.medalliesdirect.net
- https://app.meldrx.com/api/fhir/uc30108_rockforduroassoc
- matthewhoulihan@rua.medalliesdirect.net
- jennifergonzalez@rua.medalliesdirect.net
- catherineeden@rua.medalliesdirect.net
- lukefrederick@rua.medalliesdirect.net
- ashleywire@rua.medalliesdirect.net
- danielsadowski@rua.medalliesdirect.net
Practitioners & affiliated clinicians
Practitioners 20
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Rockford, IL
- NPI 1063993731
-
- Nurse Practitioner
- Rockford, IL
- NPI 1417764267
-
- Urology Physician
- Maywood, IL
- NPI 1215226865
-
- Urology Physician
- Rockford, IL
- NPI 1043507866
-
- Urology Physician
- Rockford, IL
- NPI 1528196656
-
- Nurse Practitioner
- Rockford, IL
- NPI 1598216657
-
- Adult Health Nurse Practitioner
- Peoria, IL
- NPI 1982933974
-
- Urology Physician
- Lake Barrington, IL
- NPI 1174941769
-
- Anatomic Pathology & Clinical Pathology Physician
- Moline, IL
- NPI 1659372555
-
- Urology Physician
- Springfield, IL
- NPI 1376958637
-
- Urology Physician
- Springfield, IL
- NPI 1487817235
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143504000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1703203200000",
"number": "1194786558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "351 EXECUTIVE PKWY",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075339",
"telephone_number": "815-398-4057",
"fax_number": "815-398-0220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 EXECUTIVE PKWY",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075339",
"telephone_number": "815-398-4057",
"fax_number": "815-398-0220"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROCKFORD UROLOGICAL ASSOCIATES, LTD.",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-28",
"last_updated": "2023-12-22",
"certification_date": "2023-12-22",
"status": "A",
"authorized_official_last_name": "PICK",
"authorized_official_first_name": "JON",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "815-398-4057"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Urology",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036058803",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036099544",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036066868",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036080935",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036067790",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036051080",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036054674",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.