NPIMap

Individual provider Active NPI

Jason Rogers, PA

  • Physician Assistant
  • Lodi, CA
National Provider Identifier
1669970778
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
55269 Issued in CA
Practice address
975 S Fairmont Ave
Lodi, CA 95240-5118
Phone
(209) 334-3411
NPI assigned
Jan 24, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 7007 AZ
Physician Assistant 363A00000X 55269 CA Primary

Addresses

Primary practice location

975 S Fairmont Ave
Lodi, CA 95240-5118

Mailing address

8450 E Bonita Dr
Scottsdale, AZ 85250-7414
Phone (480) 370-0949

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180725001703 CA Practitioner - Physician Assistant 8022365816 Reassigns benefits to 3 organizations
I20201214000716 AZ Practitioner - Physician Assistant 8022365816 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7007AZMDPhysical Therapist

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1669970778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8450 E BONITA DR",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852507414",
            "telephone_number": "480-370-0949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405118",
            "telephone_number": "209-334-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "JASON",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-24",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7007",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "55269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.