Lisa Rogers, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA51334 Issued in CA

Practice address

565 N Mount Vernon Ave
San Bernardino, CA 92411-2661

Phone

(909) 884-9091

NPI assigned

Feb 5, 2014

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lisa.rogers.1@29786.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.

• Southern California Primary Care Canyon Lake Urgent & Family Care

  dba Danesh Medical Group

  • Non-Pharmacy Dispensing Site
  • Lake Elsinore, CA
  • NPI 1710242474
  NPD

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

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1619391182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31581 CANYON ESTATES DR",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925320424",
            "telephone_number": "951-244-3500",
            "fax_number": "951-244-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 N MOUNT VERNON AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924112661",
            "telephone_number": "909-884-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "LISA",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-05",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA51334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vicki Rodriguez
• Kylie Nicole Roeder
• Ryan Matthew Rogan
• Allan Paul Rogers
• Isabel Lorraine Rogers
• Regina Rae Rogers
• Jennifer Marlana Rohrman, B.A.
• Rojas Health Ride LLC
• Rosemary Rojas-Angeles
• Gloria Frances Rojas

• Physician Assistant in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; 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.