| Innovative Physician Services Llc | |
|
490 Page Boulevard Springfield MA 01104 | |
| (413) 349-5063 | |
| (413) 363-2857 |
| Full Name | Innovative Physician Services Llc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 490 Page Boulevard, Springfield, Massachusetts |
| Authorized Official Name and Position | Adnan M Dahdul (OWNER/CEO/OFFICER) |
| Authorized Official Contact | 4133016019 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Physician Services Llc 95 Frank B Murray St Springfield MA 01103-1106 Ph: (413) 301-6019 | Innovative Physician Services Llc 490 Page Boulevard Springfield MA 01104 Ph: (413) 349-5063 |
| NPI Number | 1922096049 |
|---|---|
| Provider Enumeration Date | 10/12/2005 |
| Last Update Date | 02/01/2024 |
| Certification Date | 02/01/2024 |
| Medicare PECOS PAC ID | 1456348127 |
|---|---|
| Medicare Enrollment ID | O20040427000199 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922096049 | NPI | - | NPPES |
| 110068493C | Medicaid | MA | |
| 30214102 | Medicaid | NH | |
| M18224 | Other | MA | BLUE CROSS |
| 9721690 | Medicaid | MA | |
| 118236600 | Medicaid | FL |
| Provider Name | Kevin Carbone |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1205826567 PECOS PAC ID: 7012904790 Enrollment ID: I20040426001562 |
| Provider Name | Ann Maria L Elder |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1720064983 PECOS PAC ID: 4880583012 Enrollment ID: I20040512000261 |
| Provider Name | Adekunle G Fajana |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396727806 PECOS PAC ID: 2365480498 Enrollment ID: I20050420000271 |
| Provider Name | William F Mulroy |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1518920636 PECOS PAC ID: 4385682996 Enrollment ID: I20050422000637 |
| Provider Name | David B Peterson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619918752 PECOS PAC ID: 1355327578 Enrollment ID: I20050426001247 |
| Provider Name | Anthony E Kusiak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831258102 PECOS PAC ID: 9032130752 Enrollment ID: I20051209000225 |
| Provider Name | Richard A Crowe |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558404749 PECOS PAC ID: 9830108356 Enrollment ID: I20060411000795 |
| Provider Name | Francisco K Serrano |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1821037565 PECOS PAC ID: 1759424799 Enrollment ID: I20100129000708 |
| Provider Name | Leonardo Samalot |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1093007031 PECOS PAC ID: 4082873948 Enrollment ID: I20120313000050 |
| Provider Name | Emily Roussi |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1649679739 PECOS PAC ID: 4183843204 Enrollment ID: I20140922001706 |
| Provider Name | Lauren Simon |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1922272947 PECOS PAC ID: 3476626995 Enrollment ID: I20150313002165 |
| Provider Name | Frank Frausto |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1356523096 PECOS PAC ID: 4385717925 Enrollment ID: I20150914000740 |
| Provider Name | Kathryn E Macgregor |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1972714830 PECOS PAC ID: 9234416421 Enrollment ID: I20170425001609 |
| Provider Name | Arnaldo R Cruz Igartua |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013110899 PECOS PAC ID: 5496011330 Enrollment ID: I20171109002655 |
| Provider Name | Lisa Kern |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1508360454 PECOS PAC ID: 7810251048 Enrollment ID: I20180515002942 |
| Provider Name | Alina Leclaire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396386512 PECOS PAC ID: 2961837240 Enrollment ID: I20200114002666 |
| Provider Name | Mark A Sullivan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1306874227 PECOS PAC ID: 3870400765 Enrollment ID: I20200721003146 |
| Provider Name | Mikhail Klakotskiy |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346824836 PECOS PAC ID: 9436559853 Enrollment ID: I20210607001568 |
| Provider Name | Emily Ann Bushway |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1902568611 PECOS PAC ID: 1658760855 Enrollment ID: I20211109002348 |
| Provider Name | Ian Giuttari |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1386254829 PECOS PAC ID: 8325467897 Enrollment ID: I20211110000103 |
| Provider Name | Antonella Martone |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1821717232 PECOS PAC ID: 4880061217 Enrollment ID: I20221027002401 |
| Provider Name | Stephanie Lynn Collins |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1003321878 PECOS PAC ID: 8224405667 Enrollment ID: I20221027002870 |
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