Krystal W Rogge

Primary specialty

OptometristTaxonomy code 152W00000X

License

2018024194 Issued in MO

Practice address

201 E 3Rd St
Cameron, MO 64429-1706

Phone

(816) 632-7979

NPI assigned

Aug 23, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Krystal W Lewallen Former name

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

John H McDougall OD PCGroup PAC ID 4587903786, 13 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• John H McDougall OD PC

  dba Eyecare Specialties

  • Optometrist
  • Beatrice, NE
  • NPI 1154894608
  Medicare reassignment Care Compare group NPD
• John H McDougall OD PC

  dba EyeCare Specialties

  • Optometrist
  • Lincoln, NE
  • NPI 1245791045
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534982400000",
    "number": "1245711746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2441 NW PRAIRIE VIEW RD",
            "city": "PLATTE CITY",
            "state": "MO",
            "postal_code": "640797627",
            "telephone_number": "816-858-2522",
            "fax_number": "816-858-2946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E 3RD ST",
            "city": "CAMERON",
            "state": "MO",
            "postal_code": "644291706",
            "telephone_number": "816-632-7979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1504 N Church Rd Ste C",
            "address_purpose": "LOCATION",
            "city": "Liberty",
            "state": "MO",
            "postal_code": "640687163",
            "country_code": "US",
            "telephone_number": "816-781-3442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROGGE",
        "first_name": "KRYSTAL",
        "middle_name": "W",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-23",
        "last_updated": "2018-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2018024194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1578598041",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTAL",
            "last_name": "LEWALLEN",
            "middle_name": "W",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jacob Randal Rash, MD
• Rem Missouri, LLC (dba Missouri MENTOR)
• Marjorie Marie Rhoads, D.C. RN
• Lindsay J Rice, MD
• Ashlyn Ridgeway
• Ashley Schildknecht, SLP
• Michelle Schultz
• Shahzad Shafique, M.D.
• Natali Shaver Dominguez
• Garold Wayne Smith, LMSW

• Optometrist in Cameron, MO
• Providers in Cameron, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.

Verify at the official NPI Registry.