Provider Demographics
NPI:1285641530
Name:ROGERS, JARED (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:217-366-1326
Mailing Address - Fax:217-366-6106
Practice Address - Street 1:1801 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-6217
Practice Address - Country:US
Practice Address - Phone:217-366-8130
Practice Address - Fax:217-366-6106
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36084031OtherBCBS
IL080190838OtherRAILROAD MEDICARE
IL023284OtherHEALTH ALLIANCE
IL472301OtherHEALTHLINK
IL7215059OtherBCBS PPO
ILIL01N1OtherJOHN DEERE
IL036084031Medicaid
IL0360840311Medicaid
IL36084031OtherBCBS
ILK32689Medicare PIN
IL0360840311Medicaid