| St Vincent Pediatric Subspecialties | |
|
2001 W 86th St Indianapolis IN 46260-1902 | |
| (317) 338-2273 | |
| Not Available |
| Full Name | St Vincent Pediatric Subspecialties |
|---|---|
| Speciality | Pediatrics |
| Location | 2001 W 86th St, Indianapolis, Indiana |
| Authorized Official Name and Position | Kevin Mcandrews (VICE PRESIDENT) |
| Authorized Official Contact | 3175833194 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Vincent Pediatric Subspecialties 10330 N Meridian St Suite 201 Indianapolis IN 46290-1024 Ph: () - | St Vincent Pediatric Subspecialties 2001 W 86th St Indianapolis IN 46260-1902 Ph: (317) 338-2273 |
| NPI Number | 1013967736 |
|---|---|
| Provider Enumeration Date | 05/11/2006 |
| Last Update Date | 11/17/2014 |
| Medicare PECOS PAC ID | 1557313939 |
|---|---|
| Medicare Enrollment ID | O20050214000627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013967736 | NPI | - | NPPES |
| 200505130P | Medicaid | IN | |
| 200901000B | Medicaid | IN | |
| 200505130M | Medicaid | IN | |
| 200505130S | Medicaid | IN | |
| 200505130U | Medicaid | IN | |
| 200505130Y | Medicaid | IN | |
| 200505130I | Medicaid | IN | |
| 200505130C | Medicaid | IN | |
| 200505130J | Medicaid | IN | |
| 200505130R | Medicaid | IN | |
| 200505130V | Medicaid | IN | |
| 200505130X | Medicaid | IN | |
| 200505130E | Medicaid | IN | |
| 200505130F | Medicaid | IN | |
| 200505130K | Medicaid | IN | |
| 200505130L | Medicaid | IN | |
| 200505130O | Medicaid | IN | |
| 200505130H | Medicaid | IN | |
| 200505130N | Medicaid | IN | |
| 200505130W | Medicaid | IN | |
| 2602026 | Medicaid | OH | |
| 200505130B | Medicaid | IN | |
| 200505130D | Medicaid | IN | |
| 200505130T | Medicaid | IN | |
| 200505130Z | Medicaid | IN | |
| 200901000A | Medicaid | IN | |
| 200505130A | Medicaid | IN | |
| 200505130G | Medicaid | IN | |
| 200505130Q | Medicaid | IN | |
| 200901000C | Medicaid | IN | |
| 2645178 | Medicaid | OH |
| Provider Name | Cheryl D G Klein |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700860616 PECOS PAC ID: 0345226841 Enrollment ID: I20040625000586 |
| Provider Name | Luis Fernando Escobar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053396135 PECOS PAC ID: 1254306558 Enrollment ID: I20040831000391 |
| Provider Name | Shivika Jain |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659356202 PECOS PAC ID: 7113992421 Enrollment ID: I20040831000429 |
| Provider Name | Saira Zakir Waheed |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932182797 PECOS PAC ID: 3274502679 Enrollment ID: I20041001000703 |
| Provider Name | Kristin J Hem |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023007440 PECOS PAC ID: 4981663572 Enrollment ID: I20041008000443 |
| Provider Name | June C Murphy |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912933771 PECOS PAC ID: 8921064486 Enrollment ID: I20041207000010 |
| Provider Name | Donald J Mcintire |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1316022189 PECOS PAC ID: 9436108420 Enrollment ID: I20050117000532 |
| Provider Name | David Gray Zipes |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689658486 PECOS PAC ID: 4385697614 Enrollment ID: I20050228000338 |
| Provider Name | Ronda Alazan Hamaker |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1174572184 PECOS PAC ID: 8224084041 Enrollment ID: I20050324000750 |
| Provider Name | Lanette C Brown Jones |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1598749772 PECOS PAC ID: 5193759298 Enrollment ID: I20050919000645 |
| Provider Name | Joseph Francis Bellflower |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1376527960 PECOS PAC ID: 9931134533 Enrollment ID: I20051003000526 |
| Provider Name | Khaled K. Bshesh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1083749998 PECOS PAC ID: 4587689856 Enrollment ID: I20051006000397 |
| Provider Name | Deborah A Ronco |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043269830 PECOS PAC ID: 5597778324 Enrollment ID: I20060724000025 |
| Provider Name | Daniel Seth Miller |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1144263120 PECOS PAC ID: 7214936665 Enrollment ID: I20061212000355 |
| Provider Name | Leyla Akanli |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881634392 PECOS PAC ID: 8224041355 Enrollment ID: I20070208000290 |
| Provider Name | Tronya Nycholl Hawkins |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1619059276 PECOS PAC ID: 4587767140 Enrollment ID: I20070320000227 |
| Provider Name | Tameka Shannel Oneal |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1558443127 PECOS PAC ID: 3375646938 Enrollment ID: I20070320000257 |
| Provider Name | Bassem I Razzouk |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1124021829 PECOS PAC ID: 1658476981 Enrollment ID: I20070416000467 |
| Provider Name | Richard W Gates |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1306812078 PECOS PAC ID: 8325144934 Enrollment ID: I20070427000330 |
| Provider Name | Angela D Stevens |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1093781460 PECOS PAC ID: 2567568132 Enrollment ID: I20070430000032 |
| Provider Name | Denise L Carpenter |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1619074036 PECOS PAC ID: 5395842884 Enrollment ID: I20070517000407 |
| Provider Name | Brandy M Hughes |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1497972665 PECOS PAC ID: 3274631429 Enrollment ID: I20070612000146 |
| Provider Name | Elizabeth Ann Schaefer |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1174652382 PECOS PAC ID: 1557460961 Enrollment ID: I20070626000714 |
| Provider Name | Lisa Marie Mcguire |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790802064 PECOS PAC ID: 9739288028 Enrollment ID: I20070627000552 |
| Provider Name | Jessica Farrell Goodman |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1831112093 PECOS PAC ID: 1456356971 Enrollment ID: I20070628000001 |
| Provider Name | Catherine Watts |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922032390 PECOS PAC ID: 7113019084 Enrollment ID: I20070823000133 |
| Provider Name | Stacey Lynne Yeo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245313832 PECOS PAC ID: 8729169248 Enrollment ID: I20080122000566 |
| Provider Name | Meenu Goel |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1447457346 PECOS PAC ID: 4486738465 Enrollment ID: I20080229000046 |
| Provider Name | Susan Schneider Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386818144 PECOS PAC ID: 9830268481 Enrollment ID: I20080521000881 |
| Provider Name | Kara Renee Vonderau |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588836563 PECOS PAC ID: 5890867188 Enrollment ID: I20080701000563 |
| Provider Name | Evan R Kokoska |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1962592469 PECOS PAC ID: 8123019304 Enrollment ID: I20080722000409 |
| Provider Name | Elizabeth Ann Kuonen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1801006150 PECOS PAC ID: 5991879637 Enrollment ID: I20080730000097 |
| Provider Name | Elizabeth S Tysklind |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1972774545 PECOS PAC ID: 4981772712 Enrollment ID: I20081007000628 |
| Provider Name | Adam K Hiett |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1376652636 PECOS PAC ID: 2062570575 Enrollment ID: I20081027000616 |
| Provider Name | Dawn Marie Zimmer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1336258698 PECOS PAC ID: 8022171461 Enrollment ID: I20090112000711 |
| Provider Name | Mona Auni Zawaideh |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1992864136 PECOS PAC ID: 5294763397 Enrollment ID: I20090331000346 |
| Provider Name | Jason M Blocksom |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1144488495 PECOS PAC ID: 2062559297 Enrollment ID: I20100625000335 |
| Provider Name | Martin C Vincent |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932154820 PECOS PAC ID: 9133245244 Enrollment ID: I20100927000621 |
| Provider Name | Wendy L Woodard |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184882862 PECOS PAC ID: 0840487054 Enrollment ID: I20101214000003 |
| Provider Name | Don T Granger |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1972681229 PECOS PAC ID: 0244322345 Enrollment ID: I20110110000019 |
| Provider Name | Leanne Donnelly Fought |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1689975625 PECOS PAC ID: 6901085687 Enrollment ID: I20110127000083 |
| Provider Name | John T Cleary |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1942340799 PECOS PAC ID: 0840471926 Enrollment ID: I20110222001179 |
| Provider Name | Kelly Marie Batthauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043405178 PECOS PAC ID: 8224219100 Enrollment ID: I20110225000071 |
| Provider Name | Hilary Gaudreau |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194865956 PECOS PAC ID: 0941482764 Enrollment ID: I20110315000458 |
| Provider Name | Christina A Kline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760408314 PECOS PAC ID: 5890971881 Enrollment ID: I20110509000179 |
| Provider Name | Aaron N Dewees |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346206737 PECOS PAC ID: 8628256955 Enrollment ID: I20110708000508 |
| Provider Name | Kara A Borcherding |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1629366414 PECOS PAC ID: 2264604651 Enrollment ID: I20111006000602 |
| Provider Name | Lindsay Susan Nesbitt |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1558536516 PECOS PAC ID: 1355514373 Enrollment ID: I20111107000629 |
| Provider Name | Cara Diane Summitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588941108 PECOS PAC ID: 0648444778 Enrollment ID: I20111129000373 |
| Provider Name | Timothy Feeney |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1215077938 PECOS PAC ID: 4284800772 Enrollment ID: I20120105000007 |
| Provider Name | Andrew L. Beardsley |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1093976615 PECOS PAC ID: 5890952063 Enrollment ID: I20120131000790 |
| Provider Name | Nahid Eftekhari Marsden |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1528250438 PECOS PAC ID: 5991869307 Enrollment ID: I20120511000445 |
| Provider Name | Jonathan Howard Wilhite |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1912165580 PECOS PAC ID: 1759545221 Enrollment ID: I20120613000277 |
| Provider Name | Kenton Shawn Hilbish |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1205061389 PECOS PAC ID: 5496910721 Enrollment ID: I20120711000368 |
| Provider Name | James Christopher Pappas |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1710928148 PECOS PAC ID: 8527213123 Enrollment ID: I20130306000028 |
| Provider Name | Melinda Sue-anne Mumford-dawdy |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720250665 PECOS PAC ID: 0446496616 Enrollment ID: I20130412000115 |
| Provider Name | Daniel Wade Mckenney |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1215911201 PECOS PAC ID: 6507825502 Enrollment ID: I20130518000061 |
| Provider Name | Taveepong Terayanont |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427087188 PECOS PAC ID: 1052203411 Enrollment ID: I20130621000548 |
| Provider Name | Stefanie M Dunn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790036937 PECOS PAC ID: 9234379769 Enrollment ID: I20130705000402 |
| Provider Name | Donald Joseph Miller |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1114241056 PECOS PAC ID: 0345483533 Enrollment ID: I20130909000434 |
| Provider Name | Elizabeth S Cottongim |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1053541169 PECOS PAC ID: 5698926632 Enrollment ID: I20130918000692 |
| Provider Name | Emily Schele Large |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699934091 PECOS PAC ID: 1850450255 Enrollment ID: I20131002000673 |
| Provider Name | Ashley N Coak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497000798 PECOS PAC ID: 9335375724 Enrollment ID: I20131113000151 |
| Provider Name | Megen Elizabeth Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508290651 PECOS PAC ID: 2163650144 Enrollment ID: I20140121001183 |
| Provider Name | Jonathan Wood Buechler |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699947341 PECOS PAC ID: 2668619529 Enrollment ID: I20140529001662 |
| Provider Name | Loraine R Condrey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043622533 PECOS PAC ID: 7517181431 Enrollment ID: I20140617000090 |
| Provider Name | Aaron Ryan Pitzele |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1215268230 PECOS PAC ID: 5294959037 Enrollment ID: I20140617001377 |
| Provider Name | Eric Edward Tibesar |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1659527786 PECOS PAC ID: 5698820702 Enrollment ID: I20140618000836 |
| Provider Name | Rachel Nicole Kearby |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1790951119 PECOS PAC ID: 4082852777 Enrollment ID: I20140618001062 |
| Provider Name | Melissa Beth Leedy |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174796494 PECOS PAC ID: 4183849417 Enrollment ID: I20140630002027 |
| Provider Name | Jason R Wiles |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093988107 PECOS PAC ID: 3678747300 Enrollment ID: I20140703001879 |
| Provider Name | Lauren Nicole Brankle |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1740579929 PECOS PAC ID: 6709002587 Enrollment ID: I20140731001339 |
| Provider Name | Avinash Patil |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720291024 PECOS PAC ID: 5496885915 Enrollment ID: I20140904002523 |
| Provider Name | Lisa Marie Richmond |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1114127768 PECOS PAC ID: 5294870713 Enrollment ID: I20140923000848 |
| Provider Name | Jessica Nell Green |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578604773 PECOS PAC ID: 6800034778 Enrollment ID: I20140923002392 |
| Provider Name | Aaron G Scholer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1861471070 PECOS PAC ID: 2062444227 Enrollment ID: I20141001002218 |
| Provider Name | Krystal A R Widau |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780973941 PECOS PAC ID: 4688895204 Enrollment ID: I20141024000662 |
| Provider Name | Reisha S. Patel |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1265695902 PECOS PAC ID: 8325281389 Enrollment ID: I20141209002627 |
| Provider Name | Anthony W Coddington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053717900 PECOS PAC ID: 3870818370 Enrollment ID: I20150204000377 |
| Provider Name | Shea Nichele Aulbach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245489723 PECOS PAC ID: 3870571532 Enrollment ID: I20150210000365 |
| Provider Name | Elizabeth Carroll Dodson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1811191398 PECOS PAC ID: 9335332071 Enrollment ID: I20150217000113 |
| Provider Name | Peter Sebastian Marcus |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1962431213 PECOS PAC ID: 5890971956 Enrollment ID: I20150306000834 |
| Provider Name | Melissa Woods Landis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770744757 PECOS PAC ID: 3779758461 Enrollment ID: I20150722004778 |
| Provider Name | Paula A Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609841527 PECOS PAC ID: 7113924622 Enrollment ID: I20151013001334 |
| Provider Name | Julia Kathrin Ohara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912370636 PECOS PAC ID: 9234430141 Enrollment ID: I20151218000899 |
| Provider Name | Olatunji Walter Williams |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1952474710 PECOS PAC ID: 1759484140 Enrollment ID: I20160209001142 |
| Provider Name | Joseph Almonte Riego |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366671323 PECOS PAC ID: 3577868637 Enrollment ID: I20160226001529 |
| Provider Name | Lori Ann Carr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558528133 PECOS PAC ID: 7517262470 Enrollment ID: I20160302000047 |
| Provider Name | Kristen Ann Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487954707 PECOS PAC ID: 7113225574 Enrollment ID: I20160419000043 |
| Provider Name | Katherine J Kelley |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1619294931 PECOS PAC ID: 9739326356 Enrollment ID: I20160512000275 |
| Provider Name | Ashley Michelle Mcfarlane |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154663011 PECOS PAC ID: 3971893454 Enrollment ID: I20160613001348 |
| Provider Name | Christian A Beuschel |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568805752 PECOS PAC ID: 6103117676 Enrollment ID: I20160614001978 |
| Provider Name | Nicole Lee Plenty |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1841429602 PECOS PAC ID: 8921220757 Enrollment ID: I20160722000458 |
| Provider Name | Adrian Lee Mcguire |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457792376 PECOS PAC ID: 4981997962 Enrollment ID: I20160728001135 |
| Provider Name | Sandy A Bowersox |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629248877 PECOS PAC ID: 9335433507 Enrollment ID: I20160810002430 |
| Provider Name | Jessica Leigh Greene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548614191 PECOS PAC ID: 4789979154 Enrollment ID: I20160824001259 |
| Provider Name | Benjamin Grant Commons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023461084 PECOS PAC ID: 6406142280 Enrollment ID: I20160902000519 |
| Provider Name | Kate Callahan Crabtree |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669824793 PECOS PAC ID: 0547557415 Enrollment ID: I20160920002025 |
| Provider Name | Amy Rene Heincker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447601224 PECOS PAC ID: 3476834268 Enrollment ID: I20170110003004 |
| Provider Name | Jessica Lynn Barfield |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1881856037 PECOS PAC ID: 2860681244 Enrollment ID: I20170410001964 |
| Provider Name | Debra Ann Moon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154772465 PECOS PAC ID: 8820375058 Enrollment ID: I20170426000050 |
| Provider Name | Rachel Kochert Dunn |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1649569419 PECOS PAC ID: 3779850771 Enrollment ID: I20170523001358 |
| Provider Name | Kavya Puranik |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710234349 PECOS PAC ID: 2961770243 Enrollment ID: I20170608002043 |
| Provider Name | Morgan Danielle Crum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164961660 PECOS PAC ID: 0446528087 Enrollment ID: I20170622001561 |
| Provider Name | Rebecca Jane Rothstein |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1437569951 PECOS PAC ID: 0345518981 Enrollment ID: I20170622001591 |
| Provider Name | Jason L Buckner |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1750675518 PECOS PAC ID: 2860793114 Enrollment ID: I20170627000757 |
| Provider Name | Lauren Bader James |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265708333 PECOS PAC ID: 4284939034 Enrollment ID: I20170628001947 |
| Provider Name | Hilary Ann White |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780901108 PECOS PAC ID: 6901191907 Enrollment ID: I20170717000213 |
| Provider Name | Russell Thomas Chowning |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1205078565 PECOS PAC ID: 5294005963 Enrollment ID: I20170728000625 |
| Provider Name | Chandar Ramanathan |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1992840425 PECOS PAC ID: 5193858512 Enrollment ID: I20170801000632 |
| Provider Name | Parul Vasant Vora |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689719114 PECOS PAC ID: 1850533936 Enrollment ID: I20170801000738 |
| Provider Name | Neil Patrick Connor |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1588689889 PECOS PAC ID: 5890878078 Enrollment ID: I20170914001091 |
| Provider Name | Kaitlin E Alsman |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1568980134 PECOS PAC ID: 9638445810 Enrollment ID: I20171017001580 |
| Provider Name | Jaclyn Marie Piechocki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972013571 PECOS PAC ID: 1254607005 Enrollment ID: I20171023000267 |
| Provider Name | Ashley Rose Kroeger |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1497045421 PECOS PAC ID: 4385946227 Enrollment ID: I20171024000039 |
| Provider Name | Sasha M Davidson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1407992167 PECOS PAC ID: 7911071022 Enrollment ID: I20171204001705 |
| Provider Name | Amanda Behny Austin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023522539 PECOS PAC ID: 6406113075 Enrollment ID: I20171206003384 |
| Provider Name | Jamie Hembrecht |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770981201 PECOS PAC ID: 5395003214 Enrollment ID: I20180306002176 |
| Provider Name | Enrico Joseph Stazzone |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1255306015 PECOS PAC ID: 8426942905 Enrollment ID: I20180529002406 |
| Provider Name | Matthew David Abbott |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1053579615 PECOS PAC ID: 2668618554 Enrollment ID: I20180602000049 |
| Provider Name | Bradley Thomas Tinkle |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831120229 PECOS PAC ID: 3375528581 Enrollment ID: I20180605000331 |
| Provider Name | Kelsey Anne Montgomery |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578838660 PECOS PAC ID: 8820368764 Enrollment ID: I20180710002620 |
| Provider Name | Benjamin Bova |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932581030 PECOS PAC ID: 0345556767 Enrollment ID: I20180723000709 |
| Provider Name | Vinay Puri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1275531345 PECOS PAC ID: 3274504667 Enrollment ID: I20180806001399 |
| Provider Name | Kelly Marie Brinkley |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730445495 PECOS PAC ID: 5991942690 Enrollment ID: I20180817002636 |
| Provider Name | Sebastian Zavoian |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1568850261 PECOS PAC ID: 5799034732 Enrollment ID: I20180823002565 |
| Provider Name | Hollie Elizabeth Ainley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417451147 PECOS PAC ID: 3476802422 Enrollment ID: I20180823002755 |
| Provider Name | Hannah B Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295218071 PECOS PAC ID: 2264783588 Enrollment ID: I20180926002173 |
| Provider Name | Jenna Keikilani Maple |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356832638 PECOS PAC ID: 7719238914 Enrollment ID: I20180927001957 |
| Provider Name | Melissa Jean Yanckello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679056329 PECOS PAC ID: 3971854043 Enrollment ID: I20180928002217 |
| Provider Name | Kiley Kristine Mattox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841775277 PECOS PAC ID: 5193061711 Enrollment ID: I20190117002815 |
| Provider Name | Laurie Minarich |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1104950708 PECOS PAC ID: 0941450928 Enrollment ID: I20190226002620 |
| Provider Name | Dawn Renee Utz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073869160 PECOS PAC ID: 3971563479 Enrollment ID: I20190318001763 |
| Provider Name | Caroline Wind Slabaugh |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1962849596 PECOS PAC ID: 8224379771 Enrollment ID: I20190410000069 |
| Provider Name | Mary Ebueku-smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639514805 PECOS PAC ID: 8426329897 Enrollment ID: I20190523000101 |
| Provider Name | Jennifer C Hamilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720007073 PECOS PAC ID: 5698009090 Enrollment ID: I20190618002769 |
| Provider Name | Marissa Young-hughes |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1972966638 PECOS PAC ID: 7911290523 Enrollment ID: I20190619003161 |
| Provider Name | Michelle M Gombas |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396001194 PECOS PAC ID: 9133425093 Enrollment ID: I20190719000843 |
| Provider Name | Tovah A Buikema |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1063714459 PECOS PAC ID: 8921308149 Enrollment ID: I20190724000202 |
| Provider Name | Eric Kirtwei Chang |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710220744 PECOS PAC ID: 0042549925 Enrollment ID: I20190903002347 |
| Provider Name | Brett W Engbrecht |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1932165479 PECOS PAC ID: 1658312913 Enrollment ID: I20191009000902 |
| Provider Name | Nizar Kherallah |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1669467726 PECOS PAC ID: 0547267197 Enrollment ID: I20191018000627 |
| Provider Name | Megan M Field |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1740694306 PECOS PAC ID: 3971727470 Enrollment ID: I20191022001804 |
| Provider Name | Sarah Steinke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477115699 PECOS PAC ID: 7517399132 Enrollment ID: I20191119002174 |
| Provider Name | Shaun Hicks |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073618575 PECOS PAC ID: 5395178651 Enrollment ID: I20191127002422 |
| Provider Name | Kevin M Stutey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1275754830 PECOS PAC ID: 9234306481 Enrollment ID: I20191205003170 |
| Provider Name | Kristi N Browning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992954309 PECOS PAC ID: 5991139412 Enrollment ID: I20191216002355 |
| Provider Name | Chad A Wiesenauer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1861616732 PECOS PAC ID: 7012004369 Enrollment ID: I20200106001303 |
| Provider Name | Jaime L Below |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497078190 PECOS PAC ID: 2769513290 Enrollment ID: I20200110001210 |
| Provider Name | Leslie M Antonelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013193457 PECOS PAC ID: 4385071091 Enrollment ID: I20200218002991 |
| Provider Name | Rebecca Marie Burns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104466945 PECOS PAC ID: 9234568130 Enrollment ID: I20200327001966 |
| Provider Name | Samantha Skinner Wilson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356704324 PECOS PAC ID: 2961773809 Enrollment ID: I20200504000855 |
| Provider Name | Caitlin Hall |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1669890802 PECOS PAC ID: 7618271859 Enrollment ID: I20200513000810 |
| Provider Name | Renee Triplet |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023274131 PECOS PAC ID: 3173823077 Enrollment ID: I20200609002721 |
| Provider Name | Katherine Wynne Han |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1679002778 PECOS PAC ID: 4880016153 Enrollment ID: I20200616000984 |
| Provider Name | Angela Barton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588019004 PECOS PAC ID: 5395036719 Enrollment ID: I20200623002068 |
| Provider Name | Jaime L Floyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336783208 PECOS PAC ID: 4789006362 Enrollment ID: I20200629000748 |
| Provider Name | Elizabeth Page Clawson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912096207 PECOS PAC ID: 7214350008 Enrollment ID: I20200713001991 |
| Provider Name | Amber Boksa |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255863742 PECOS PAC ID: 0244654812 Enrollment ID: I20200716000921 |
| Provider Name | Constantine Mavroudis |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1952396897 PECOS PAC ID: 9638060312 Enrollment ID: I20200720002295 |
| Provider Name | Claire Richey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891327730 PECOS PAC ID: 5193149110 Enrollment ID: I20200723002447 |
| Provider Name | Cindy Ann Syrek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245861848 PECOS PAC ID: 2961826888 Enrollment ID: I20200723002670 |
| Provider Name | Gwendolyn Shelton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285649749 PECOS PAC ID: 9739282351 Enrollment ID: I20200803000845 |
| Provider Name | Jori Danae Matushek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467077578 PECOS PAC ID: 0749607521 Enrollment ID: I20200825001082 |
| Provider Name | Mary E. Leins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356779722 PECOS PAC ID: 0749690022 Enrollment ID: I20201028001945 |
| Provider Name | Katherine Kemmerlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629504246 PECOS PAC ID: 3971914078 Enrollment ID: I20201120001957 |
| Provider Name | Michelle Mastin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003869116 PECOS PAC ID: 5597789628 Enrollment ID: I20201130001373 |
| Provider Name | John Michael Karamichalis |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1467651083 PECOS PAC ID: 6608045992 Enrollment ID: I20201208001714 |
| Provider Name | Monica Vermani Durr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538667076 PECOS PAC ID: 5991118259 Enrollment ID: I20210105000917 |
| Provider Name | Kelli Robertson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1003417064 PECOS PAC ID: 7315350634 Enrollment ID: I20210106000361 |
| Provider Name | Stacey Stevens Schmiedecke |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124392741 PECOS PAC ID: 1153741152 Enrollment ID: I20210121002127 |
| Provider Name | Valerie Rose Florez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912411232 PECOS PAC ID: 2466868807 Enrollment ID: I20210309001915 |
| Provider Name | Sig-linda Jacobson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1033291323 PECOS PAC ID: 5698869980 Enrollment ID: I20210629002913 |
| Provider Name | Nina Azer Salfity |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346621042 PECOS PAC ID: 9638464605 Enrollment ID: I20210714001481 |
| Provider Name | Elizabeth Spiwak |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1235524182 PECOS PAC ID: 8123314945 Enrollment ID: I20210721003137 |
| Provider Name | Saif Aljemmali |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1558723007 PECOS PAC ID: 4587068614 Enrollment ID: I20210811001128 |
| Provider Name | Macie Dane Snowden |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1013586585 PECOS PAC ID: 9931503943 Enrollment ID: I20210812000295 |
| Provider Name | Thomas David Mulderink |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982086153 PECOS PAC ID: 3072918002 Enrollment ID: I20210830000163 |
| Provider Name | Leah Nanette Nave |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992146591 PECOS PAC ID: 3173928124 Enrollment ID: I20210830000888 |
| Provider Name | Stephanie Chenowith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558947788 PECOS PAC ID: 8527464551 Enrollment ID: I20210831000871 |
| Provider Name | Latisha Cecil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427621705 PECOS PAC ID: 4688070907 Enrollment ID: I20210910001669 |
| Provider Name | Eric Andonian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295402915 PECOS PAC ID: 9830596295 Enrollment ID: I20210928000667 |
| Provider Name | Emily Campbell Swart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669141776 PECOS PAC ID: 2163820010 Enrollment ID: I20211007002185 |
| Provider Name | Molly Beth Howland-lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588266068 PECOS PAC ID: 0345630711 Enrollment ID: I20211130000686 |
| Provider Name | Luanna Beauchamp |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1740224286 PECOS PAC ID: 0749211720 Enrollment ID: I20211221002066 |
| Provider Name | Patricia H Balbach |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1093868069 PECOS PAC ID: 3072904275 Enrollment ID: I20211223000568 |
| Provider Name | Madeline Rae Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336805258 PECOS PAC ID: 7012309206 Enrollment ID: I20220120001239 |
| Provider Name | Taha Ben Saad |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457465361 PECOS PAC ID: 9537552658 Enrollment ID: I20220211001212 |
| Provider Name | Melissa Ann Revard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033879168 PECOS PAC ID: 7517351661 Enrollment ID: I20220307000726 |
| Provider Name | Taylor Lee Reuter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831868884 PECOS PAC ID: 2668867664 Enrollment ID: I20220309001515 |
| Provider Name | Douglas Cipkala |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760494934 PECOS PAC ID: 2264536671 Enrollment ID: I20220506001033 |
| Provider Name | Konstantin Denev |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1437131299 PECOS PAC ID: 9234166901 Enrollment ID: I20220513000640 |
| Provider Name | Varun Gulati |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396205902 PECOS PAC ID: 6800121583 Enrollment ID: I20220713000835 |
| Provider Name | Donald George |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154332682 PECOS PAC ID: 4688716640 Enrollment ID: I20220714001915 |
| Provider Name | Elizabeth Wickstrom |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1952473118 PECOS PAC ID: 4284731662 Enrollment ID: I20220913002986 |
| Provider Name | Nicole Messer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053045021 PECOS PAC ID: 0446635601 Enrollment ID: I20220923002519 |
| Provider Name | Stacey L Ishman |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1245287101 PECOS PAC ID: 7810932274 Enrollment ID: I20221104001173 |
| Provider Name | Pedro Arrabal |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588627236 PECOS PAC ID: 0345237863 Enrollment ID: I20221202001435 |
| Provider Name | Erica Stevens |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1417375197 PECOS PAC ID: 0648540237 Enrollment ID: I20221205000217 |
| Provider Name | Amy Montgomery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992321525 PECOS PAC ID: 9234542499 Enrollment ID: I20230314002565 |
| Provider Name | Kimberly Patterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891971248 PECOS PAC ID: 5890877047 Enrollment ID: I20230321000739 |
| Provider Name | Michelle Owens |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669694063 PECOS PAC ID: 2860584109 Enrollment ID: I20230403002087 |
| Provider Name | Erin M Hedlund |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386340396 PECOS PAC ID: 0446625123 Enrollment ID: I20230411001855 |
| Provider Name | Chenoa Newbey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083704373 PECOS PAC ID: 1052350386 Enrollment ID: I20230502002966 |
| Provider Name | Mackenzie Stice |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629632799 PECOS PAC ID: 7810221496 Enrollment ID: I20230516000405 |
| Provider Name | Michael E Deroche |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1548204043 PECOS PAC ID: 3678542479 Enrollment ID: I20230609001472 |
| Provider Name | Jill Mccaulley |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669607388 PECOS PAC ID: 0749400034 Enrollment ID: I20230612000505 |
| Provider Name | Santa Bartholomew |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1316925787 PECOS PAC ID: 6103831557 Enrollment ID: I20230612002874 |
| Provider Name | Helen Schnarr |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1043900665 PECOS PAC ID: 1052779188 Enrollment ID: I20230622001738 |
| Provider Name | Lindsay Panah |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1144750381 PECOS PAC ID: 6406129618 Enrollment ID: I20230717000213 |
| Provider Name | David Morales |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1407936818 PECOS PAC ID: 2163493495 Enrollment ID: I20230718004087 |
| Provider Name | Katherynne Greve |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1376171637 PECOS PAC ID: 4284058702 Enrollment ID: I20230822003449 |
| Provider Name | Kelly Barton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1851950729 PECOS PAC ID: 9234469537 Enrollment ID: I20230824000241 |
| Provider Name | Michael Marcotte |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326046889 PECOS PAC ID: 5890751457 Enrollment ID: I20230825001313 |
| Provider Name | Erica Kay Ranard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649985375 PECOS PAC ID: 7618321829 Enrollment ID: I20230921002460 |
| Provider Name | Brianna Marie Tharp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841970852 PECOS PAC ID: 7214383744 Enrollment ID: I20231019002407 |
| Provider Name | Meredith Mueller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013698745 PECOS PAC ID: 0840646113 Enrollment ID: I20231023001348 |
| Provider Name | Jonathan W Weeks |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1376509018 PECOS PAC ID: 6305865999 Enrollment ID: I20231103001309 |
| Provider Name | Jackie Lynn Palmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932988508 PECOS PAC ID: 2466801964 Enrollment ID: I20231208002787 |
| Provider Name | Rakesh Kumar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1215256086 PECOS PAC ID: 5496904120 Enrollment ID: I20231226000610 |
| Provider Name | Elizabeth Harrelson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356498174 PECOS PAC ID: 9436200441 Enrollment ID: I20240209003019 |
| Provider Name | Jayashree Vasa |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1245447838 PECOS PAC ID: 4385719426 Enrollment ID: I20240213000719 |
| Provider Name | Madison Kay Ebnit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437839594 PECOS PAC ID: 4789028812 Enrollment ID: I20240216002438 |
| Provider Name | Garick David Hill |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1306034749 PECOS PAC ID: 1658524996 Enrollment ID: I20240228001947 |
| Provider Name | Shabana Shahanavaz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1811229107 PECOS PAC ID: 1254503014 Enrollment ID: I20240315000202 |
Louly Dentistry, Inc Dental Clinic Medicare: Medicare Enrolled Practice Location: 11530 E Washington Street, Indianapolis, IN 46229 Phone: 317-869-0000 Fax: 317-869-0233 | |
Jamestowne Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6249 S East St, Suite J, Indianapolis, IN 46227 Phone: 317-789-1000 | |
Holland Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3935 Eagle Creek Pkwy Ste A, Indianapolis, IN 46254 Phone: 317-291-1000 | |
John M. Porter Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8202 Clearvista Pkwy, Building 5 Suite B, Indianapolis, IN 46256 Phone: 317-842-6333 | |
University Pediatric Dentistry Associates Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 705 Riley Hospital Dr, Roc - Suite 4205, Indianapolis, IN 46202 Phone: 317-944-9604 Fax: 317-948-0760 | |
Castleton General & Implant Dentistry Pc Dental Clinic Medicare: Medicare Enrolled Practice Location: 6535 E 82nd St, Suite 211, Indianapolis, IN 46250 Phone: 317-849-3597 Fax: 317-913-0641 | |
Thoman Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4950 E Stop 11 Rd Ste A, Indianapolis, IN 46237 Phone: 317-865-1300 |