NPIMap

Organization Active NPI

Rna of Rockford, PLLC

  • Nephrology Physician
  • Rockford, IL
National Provider Identifier
1336326388
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
RNA OF ROCKFORD, PLLC
Practice address
612 Roxbury Rd
Rockford, IL 61107
Phone
(815) 227-8300
Fax
(815) 227-8301
NPI assigned
Jan 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

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

Authorized official

Name
Dr. Michael J Robertson, M.D.NPI 1093717027
Title
President
Phone
(815) 227-8300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RN0300X IL Primary

Addresses

Primary practice location

612 Roxbury Rd
Rockford, IL 61107

Mailing address

612 Roxbury Rd
Rockford, IL 61107-5089
Phone (815) 227-8300

Other identifiers 1

IdentifierTypeStateIssuer
DN1168OtherILRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080522000639 IL Part B Supplier - Clinic/Group Practice 3870662398 Receives reassigned benefits from 23 practitioners
Practice locations: Sycamore, IL; Sterling, IL; Rockford, IL; Dekalb, IL; Dixon, IL; Freeport, IL; Rochelle, IL
O20080530000792 WI Part B Supplier - Clinic/Group Practice 3870662398 Receives reassigned benefits from 14 practitioners
Practice locations: Beloit, WI; Janesville, WI

National Provider Directory

National Provider Directory

Locations

1001 S Annie Glidden Rd
DeKalb, IL 60115
Phone (815) 748-3074

215 E 1st St
Ste 153
Dixon, IL 61021
Phone (815) 285-5484

2410 Alft Ln
Elgin, IL 60124
Phone (847) 289-5628

1808 S West Ave
Freeport, IL 61032
Phone (815) 232-0295

2127 Midlands Ct
Sycamore, IL 60178
Phone (815) 227-8330

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1200960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713398400000",
    "number": "1336326388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 ROXBURY RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075089",
            "telephone_number": "815-227-8300",
            "fax_number": "815-227-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 ROXBURY RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61107",
            "telephone_number": "815-227-8300",
            "fax_number": "815-227-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RNA OF ROCKFORD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-22",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-227-8300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DN1168",
            "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 Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.