Provider Demographics
NPI:1699735019
Name:ROGERS, NAKIISA M (MD)
Entity type:Individual
Prefix:
First Name:NAKIISA
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAKIISA
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0859612085R0202X
IN01058163A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000618596OtherANTHEM BCBS
OH000000370417OtherANTHEM BCBS
IN200946150Medicaid
OHP00221389OtherRAILROAD MEDICARE
INP00787057OtherRAILROAD MEDICARE
OH2557504Medicaid
IL822400059OtherMEDICARE
OH2557504Medicaid
OHRO4157341Medicare PIN
IN959090HHHMedicare PIN
OHRO4157342Medicare PIN