Ryan Rogulich, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.023720 Issued in IL

Practice address

6355 Brandhorst Rd
Carterville, IL 62918-3322

Phone

(618) 519-9200

NPI assigned

Nov 3, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ryan.rogulich.1@14668.direct.athenahealth.com

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.

• Shawnee Health Service and Development Corp

  • Federally Qualified Health Center (FQHC)
  • Carterville, IL
  • NPI 1639295314

  Clinical

  Medicare reassignment NPD
• Shawnee Health Service and Development Corp

  • Federally Qualified Health Center (FQHC)
  • Murphysboro, IL
  • NPI 1245260645

  Clinical

  NPD
• Shawnee Health Service and Development Corp

  • Community/Retail Pharmacy
  • Carbondale, IL
  • NPI 1760253447
  NPD
• Shawnee Health Service and Development Corp

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
  • NPI 1073745345

  Clinical

  NPD (past)

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1427713403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CALIFORNIA ST",
            "address_2": "PO BOX 577",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "62918",
            "telephone_number": "618-519-9200",
            "fax_number": "618-985-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6355 BRANDHORST RD",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629183322",
            "telephone_number": "618-519-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGULICH",
        "first_name": "RYAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-03",
        "last_updated": "2023-09-07",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.023720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas P Robertson, DNP, APRN, FNP-C
• Anna Rose Rodgers
• Patricia Roebuck, LMHC
• Amy Rogers, MSW,LCSW
• Charmonique Rogers, MA
• Tamara Samples, MS
• Charles Robert Sanders, RN
• Jack T Sandford, MD
• Alyx Schimpf
• Brandon Secrist, MSW

• Clinical Social Worker in Carterville, IL
• Providers in Carterville, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.