| Bloomington Meadows Physicians | |
|
3600 N Prow Rd Bloomington IN 47404-1616 | |
| (812) 331-8000 | |
| (812) 331-8985 |
| Full Name | Bloomington Meadows Physicians |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 3600 N Prow Rd, Bloomington, Indiana |
| Authorized Official Name and Position | Steve Filton (SR VP CFO) |
| Authorized Official Contact | 6107683300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloomington Meadows Physicians 3600 N Prow Rd Bloomington IN 47404-1616 Ph: (812) 331-8000 | Bloomington Meadows Physicians 3600 N Prow Rd Bloomington IN 47404-1616 Ph: (812) 331-8000 |
| NPI Number | 1033298120 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 04/13/2015 |
| Medicare PECOS PAC ID | 6002707494 |
|---|---|
| Medicare Enrollment ID | O20040324000255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033298120 | NPI | - | NPPES |
| 060128000 | Other | IN | MAGELLAN |
| 107936 | Other | IN | ANTHEM |
| 200075480 | Medicaid | IN | |
| 2398043 | Other | OH | OHIO MEDICAID |
| Provider Name | Arthur Lyakhovetsky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124097142 PECOS PAC ID: 7113932351 Enrollment ID: I20060209000399 |
| Provider Name | Jennifer a Comer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669513784 PECOS PAC ID: 4486794393 Enrollment ID: I20091224000051 |
| Provider Name | Grace Thomas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104860782 PECOS PAC ID: 6608048905 Enrollment ID: I20131120000265 |
| Provider Name | Derek W Booth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568852986 PECOS PAC ID: 8022335413 Enrollment ID: I20150324000521 |
| Provider Name | Eric Lyakhovetsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134780851 PECOS PAC ID: 4082944392 Enrollment ID: I20191001000285 |
| Provider Name | Molly Renee Shankles Bullington |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346702313 PECOS PAC ID: 7810221843 Enrollment ID: I20211007000474 |
| Provider Name | Karri Woodard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447912423 PECOS PAC ID: 1355733593 Enrollment ID: I20220119002248 |
| Provider Name | Kimberly S Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265165229 PECOS PAC ID: 7416332119 Enrollment ID: I20220916000374 |
| Provider Name | Shila Thapa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356062467 PECOS PAC ID: 8325416415 Enrollment ID: I20221121002770 |
| Provider Name | Shanaz Judge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710695937 PECOS PAC ID: 2163892910 Enrollment ID: I20230112000857 |
| Provider Name | Matthew Clardy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962282509 PECOS PAC ID: 3375999865 Enrollment ID: I20231019000580 |
| Provider Name | Rachel Payne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619650215 PECOS PAC ID: 8426406455 Enrollment ID: I20231130002496 |
| Provider Name | Rachel Stahl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982452413 PECOS PAC ID: 8426596438 Enrollment ID: I20240821000947 |
| Provider Name | Shahzad Ahmad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710626106 PECOS PAC ID: 4880073857 Enrollment ID: I20250718000192 |
| Provider Name | Christian Allebach |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417586892 PECOS PAC ID: 5597187526 Enrollment ID: I20251023001066 |
| Provider Name | Jessi L Bowman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104706316 PECOS PAC ID: 7810482502 Enrollment ID: I20251219001969 |
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