NPIMap

Individual provider Active NPI

John C Maynard, MD

  • Nephrology Physician
  • Rockford, IL
National Provider Identifier
1730180878
Registry record updated Apr 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
036066422 Issued in IL
Practice address
612 Roxbury Rd
Rockford, IL 61107-5089
Phone
(815) 227-8300
Fax
(815) 227-8301
NPI assigned
Aug 10, 2005
Last updated
Apr 22, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 036066422 IL Primary

Addresses

Primary practice location

612 Roxbury Rd
Rockford, IL 61107-5089

Mailing address

612 Roxbury Rd
Rockford, IL 61107-5089
Phone (815) 227-8300

Other identifiers 4

IdentifierTypeStateIssuer
30525600MedicaidWI
036066422MedicaidIL
1616108OtherILBCBS
P00605020OtherILRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050113001026 IL Practitioner - Nephrology 3779493861 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rna of Rockford, PLLCGroup PAC ID 3870662398, 18 clinicians

Practice addresses (Care Compare)

612 Roxbury Rd
Rockford, IL 61107-5089
Phone (815) 227-8300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.99 of 100Reported as group
Quality
83.04
Promoting interoperability
100
Improvement activities
40
Cost
77.67

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates of Northern Indiana, Inc Nephrology Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: jmaynard21364@cghmc.direct-ci.com
  • Direct secure messaging: john.maynard.1@19234.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303430400000",
    "number": "1730180878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 ROXBURY RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075089",
            "telephone_number": "815-227-8300",
            "fax_number": "815-227-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 ROXBURY RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075089",
            "telephone_number": "815-227-8300",
            "fax_number": "815-227-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "JOHN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2011-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036066422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30525600",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036066422",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1616108",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00605020",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.