| Trent D Rogers, MD | |
|
55 West Tietan Street, Walla Walla, WA 99362-4445 | |
| (509) 525-3720 | |
| (509) 522-1593 |
| Full Name | Trent D Rogers |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 55 West Tietan Street, Walla Walla, Washington |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487619417 | NPI | - | NPPES |
| 129168 | Other | BLUE CROSS BLUE SHIELD | |
| 204956502 | Medicaid | MO | |
| 3269222 | Other | CIGNA | |
| H13706 | Other | MERCY | |
| 1834225 | Other | FIRST HEALTH | |
| 4435458 | Other | HEALTHLINK | |
| 204956502 | Other | MO | MEDICAID |
| 207515500 | Other | MO | MEDICAID |
| 440546366 | Other | UNITED HEALTHCARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 2000150925 (Missouri) | Secondary |
| 208000000X | Pediatrics | MD60150941 (Washington) | Primary |
| Entity Name | Privia Medical Group Washington Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780658419 PECOS PAC ID: 2264320837 Enrollment ID: O20040309000126 |
| Mailing Address | Practice Location Address |
|---|---|
| Trent D Rogers, MD 55 West Tietan Street, Walla Walla, WA 99362-4445 Ph: (509) 525-3720 | Trent D Rogers, MD 55 West Tietan Street, Walla Walla, WA 99362-4445 Ph: (509) 525-3720 |
Timothy Isamu O'connor, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 55 W Tietan St, Walla Walla, WA 99362 Phone: 509-525-3720 | |
Rebekah Dickman, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 55 W Tietan St, Walla Walla, WA 99362 Phone: 509-525-3720 Fax: 509-522-1593 | |
Donald K Ashley, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1111 S 2nd Ave, Walla Walla, WA 99362 Phone: 509-522-0100 Fax: 509-527-8010 | |
Jaslyn Esther Erickson, MD Pediatrics Medicare: May Accept Medicare Assignments Practice Location: 55 W Tietan St Bldg A, Walla Walla, WA 99362 Phone: 509-525-3720 | |
Dr. Alison E Kirby, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 55 W Tietan St, Walla Walla, WA 99362 Phone: 509-525-3720 Fax: 509-522-1578 | |
Kristin Marie Satterfield, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1111 S 2nd Ave, Walla Walla, WA 99362 Phone: 509-527-8152 |