Chester Lynn Rogers, M.D.
Individual provider Active NPI Family Medicine Physician · Bourbon, IN
NPI 1689613382 · NPPES record last updated Nov 25, 2020
Key facts
- NPI
- 1689613382
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01041632 (IN)
- Practice address
- 114 N Washington St
Bourbon, IN 46504-1623 - Phone
- (574) 342-2444
- Fax
- (574) 342-2442
- NPI assigned
- Jun 6, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01041632 | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Joseph Regional Medical Center, Inc. | Past | Accepting new patients |
Interoperability endpoints
- crogers1147596@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01041632 | IN | Yes |
Addresses
Primary practice location
114 N Washington St
Bourbon, IN 46504-1623
Mailing address
707 E Cedar St
Ste 200
South Bend, IN 46617-2057
Phone (574) 472-6700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000803855 | Other | IN | ANTHEM |
| 000001417982 | Other | IN | ANTHEM |
| 100328410 | Medicaid | IN | |
| 000001418073 | Other | IN | ANTHEM |
| 000000314564 | Other | IN | ANTHEM |
| 000000878019 | Other | IN | ANTHEM |
| 000001418170 | Other | IN | ANTHEM |
| 000001417024 | Other | IN | ANTHEM |
| 000000314564 | Other | IN | BCBS |
| 000001418134 | Other | IN | ANTHEM |
Other providers in Bourbon, IN
- Jennifer Norman
- Sherry Faye Pyke
- John M Reichert
- Rhonda Miller'S Adult Respit Care
- Right @ Home Adult Day Care Sevice
- Lori Ann Stough
- Town of Bourbon
- Triton School Corporation
- Rebecca Sue Wampler
All providers in Bourbon, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.