MEDICARE: JOHN ROGERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	036087046	IL
2	207R00000X	Internal Medicine Physician	036087046	IL
3	207R00000X	Internal Medicine Physician	01072512A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	809840044	OTHER	IL	MEDICARE INDIVIDUAL PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IL0104	OTHER	IL	JOHN DEERE
2	07215036	OTHER	IL	BCBS
3	809840	OTHER	IL	MEDICATE GROUP PTAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023086295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ROGERS MD

Provider Business Mailing Address
First Line	:	PO BOX 372
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-0372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 HEALTH CENTER DR
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-4644
Country	:	US
Telephone Number	:	217-238-4325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/24/2024

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Directions to “ JOHN ROGERS MD” Practice Location

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