NPIMap

Individual provider Active NPI

Ronald V. Washak, D.O.

  • Plastic and Reconstructive Surgery Physician
  • Rockford, IL
National Provider Identifier
1265548945
Registry record updated Jan 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
036-128815 Issued in IL
Practice address
2300 N Rockton Ave
Plastic Surgery Dept
Rockford, IL 61103-3619
Phone
(815) 971-2000
Fax
(815) 971-9924
NPI assigned
Aug 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 036-128815 IL
Facial Plastic Surgery Physician 207YS0123X 036-128815 IL
Plastic and Reconstructive Surgery Physician 2086S0122X 036-128815 IL Primary
Surgery of the Hand (Plastic Surgery) Physician 2082S0105X 036128815 IL

Addresses

Primary practice location

2300 N Rockton Ave
Plastic Surgery Dept
Rockford, IL 61103-3619

Mailing address

2300 N Rockton Ave
Plastic Surgery Dept
Rockford, IL 61103-3619
Phone (815) 971-2000

Other identifiers 1

IdentifierTypeStateIssuer
1265548945MedicaidWI

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)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036-128815ILMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Mercy Health Physicians Lima, LLC Otolaryngology Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422489600000",
    "number": "1265548945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 N ROCKTON AVE",
            "address_2": "PLASTIC SURGERY DEPT",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033619",
            "telephone_number": "815-971-2000",
            "fax_number": "815-971-9924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N ROCKTON AVE",
            "address_2": "PLASTIC SURGERY DEPT",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033619",
            "telephone_number": "815-971-2000",
            "fax_number": "815-971-9924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASHAK",
        "first_name": "RONALD",
        "middle_name": "V.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2015-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036-128815",
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "IL",
            "license": "036-128815",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "036-128815",
            "primary": true
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "IL",
            "license": "036128815",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265548945",
            "state": "WI"
        }
    ],
    "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 Jan 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.