Individual provider Active NPI

Robert James Rogers, P.A.-C

  • Physician Assistant
  • Mount Vernon, WA
National Provider Identifier
1669426417
Registry record updated Mar 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10004957 Issued in WA
Practice address
1500 Continental PL
Mount Vernon, WA 98273-4105
Phone
(360) 424-7041
Fax
(360) 424-8449
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA10004957 WA Primary

Addresses

Primary practice location

1500 Continental PL
Mount Vernon, WA 98273-4105

Mailing address

1500 Continental PL
Mount Vernon, WA 98273-4105
Phone (360) 424-7041

Other identifiers 2

IdentifierTypeStateIssuer
0203803OtherWADEPT. L&I
8441693MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060104000895 WA Practitioner - Physician Assistant 3375566458 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PeacehealthGroup PAC ID 9537073960, 292 clinicians

Practice addresses (Care Compare)

2901 Sqaulicum Pkwy
Bellingham, WA 98225-1851
Phone (360) 788-9373

3015 Squalicum Pkwy
Bellingham, WA 98225-1906

8844 Benson Rd
Lynden, WA 98264-9787
Phone (360) 318-0260

Hospital & facility affiliations

  • Peacehealth St Joseph Medical Center Hospital, Bellingham, WA, CCN 500030

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA10004957WAMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: rrogers10139@direct.peacehealth.org

Organizations & group practices 1

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301529600000",
    "number": "1669426417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 CONTINENTAL PL",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982734105",
            "telephone_number": "360-424-7041",
            "fax_number": "360-424-8449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 CONTINENTAL PL",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982734105",
            "telephone_number": "360-424-7041",
            "fax_number": "360-424-8449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "ROBERT",
        "middle_name": "JAMES",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2011-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. L&I",
            "identifier": "0203803",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8441693",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.