Active NPI
William N Georgis, M.D.
- Specialist
- Rockford, IL
National Provider Identifier
1508865692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 036053928
- Practice address
- 6030 Garrett LN
Rockford, IL 61107-6637 - Phone
- (815) 398-7600
- Fax
- (815) 398-7665
- NPI assigned
- Jul 20, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 036053928 | IL | Primary |
Addresses
Primary practice location
6030 Garrett LN
Rockford, IL 61107-6637
Mailing address
6030 Garrett LN
Rockford, IL 61107-6637
Phone (815) 398-7600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036053928 | Medicaid | IL | |
| 10100577 | Other | IL | BLUE CROSS BLUE SHIELD |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036053928 | IL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313366400000",
"number": "1508865692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6030 GARRETT LN",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611076637",
"telephone_number": "815-398-7600",
"fax_number": "815-398-7665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6030 GARRETT LN",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611076637",
"telephone_number": "815-398-7600",
"fax_number": "815-398-7665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEORGIS",
"first_name": "WILLIAM",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-20",
"last_updated": "2011-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IL",
"license": "036053928",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036053928",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "10100577",
"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 Aug 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.