Active NPI
Rodger Samuel Agre, M.D.
- Psychiatry Physician
- Incline Village, NV
National Provider Identifier
1740371228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD5740
- Practice address
- 880 Alder Ave
Incline Village, NV 89451-8215 - Phone
- (775) 832-5555
- Fax
- (775) 832-5559
- NPI assigned
- Sep 27, 2006
- Last updated
- May 20, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD5740 | NV | Primary |
Addresses
Primary practice location
880 Alder Ave
Incline Village, NV 89451-8215
Mailing address
880 Alder Ave
Incline Village, NV 89451-8215
Phone (775) 832-5555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002013035 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD5740 | NV | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274313600000",
"number": "1740371228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "880 ALDER AVE",
"city": "INCLINE VILLAGE",
"state": "NV",
"postal_code": "894518215",
"telephone_number": "775-832-5555",
"fax_number": "775-832-5559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "880 ALDER AVE",
"city": "INCLINE VILLAGE",
"state": "NV",
"postal_code": "894518215",
"telephone_number": "775-832-5555",
"fax_number": "775-832-5559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGRE",
"first_name": "RODGER",
"middle_name": "SAMUEL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2010-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NV",
"license": "MD5740",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002013035",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Incline Village, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.