Glenn Thomas Rogers, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G63479 Issued in CA

Practice address

1245 S Main St
Willits, CA 95490-4305

Phone

(707) 459-6861

Fax

(707) 456-3057

NPI assigned

May 31, 2005

Last updated

Apr 16, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• John R Glyer D Mills Matheson & Margaret Arner MDS PTR

  dba Baechtel Creek Medical Clinic

  • Rural Health Clinic/Center
  • Willits, CA
  • NPI 1568525400
  Medicare reassignment NPD

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366070400000",
    "number": "1821091133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 S MAIN ST",
            "city": "WILLITS",
            "state": "CA",
            "postal_code": "954904305",
            "telephone_number": "707-459-6861",
            "fax_number": "707-456-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 S MAIN ST",
            "city": "WILLITS",
            "state": "CA",
            "postal_code": "954904305",
            "telephone_number": "707-459-6861",
            "fax_number": "707-456-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "GLENN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2013-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G63479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne C Retallick, FNP
• Victoria Reyes
• Ann F. Robinson, ACNP
• Franklin O Rockwell, SUDRC 1 #26495
• Lindsay Rodriguez
• Monika K Rosicka, L.M, C.P.M.
• Henry W Rued, DDS
• Natalie Sadler
• Safeway Inc (Safeway Pharmacy #0965)
• Robin Sagen, RN

• Internal Medicine Physician in Willits, CA
• Providers in Willits, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.