Provider Demographics
NPI:1235308149
Name:ROGERS, JILL M (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:PAVLICEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8501 E 56TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2118
Practice Address - Country:US
Practice Address - Phone:317-621-2360
Practice Address - Fax:317-355-2855
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067373A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200993200Medicaid
INP01588248OtherRR MEDICARE
IN000000674350OtherANTHEM
INM400032285Medicare PIN
IN000000674350OtherANTHEM
INM400026677Medicare PIN
INP01588248OtherRR MEDICARE
INM400036354Medicare PIN