Active NPI
Roger Ewald, M.D.
- Ophthalmology Physician
- Champaign, IL
National Provider Identifier
1598908733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 036043360
- Practice address
- 819 Bloomington Rd
Champaign, IL 61820-2101 - Phone
- (217) 403-5401
- Fax
- (217) 366-0160
- NPI assigned
- Apr 17, 2009
- Last updated
- Apr 17, 2009
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 036043360 | IL | Primary |
Addresses
Primary practice location
819 Bloomington Rd
Champaign, IL 61820-2101
Mailing address
819 Bloomington Rd
Champaign, IL 61820-2101
Phone (217) 403-5401
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036043360 | Other | IL | LICENSEE PHYSICIAN AND SURGEON |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036043360 | IL | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239926400000",
"number": "1598908733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "819 BLOOMINGTON RD",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618202101",
"telephone_number": "217-403-5401",
"fax_number": "217-366-0160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "819 BLOOMINGTON RD",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618202101",
"telephone_number": "217-403-5401",
"fax_number": "217-366-0160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EWALD",
"first_name": "ROGER",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-17",
"last_updated": "2009-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IL",
"license": "036043360",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSEE PHYSICIAN AND SURGEON",
"identifier": "036043360",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
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- Brittany Michelle Ewing
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- Excel Prep (Excel Prep Learning Center)
- Eye Center LLC
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.