| State Of Connecticut | |
|
263 Farmington Avenue Farmington CT 06030-5355 | |
| (860) 679-2916 | |
| (860) 679-3071 |
| Full Name | State Of Connecticut |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 263 Farmington Avenue, Farmington, Connecticut |
| Authorized Official Name and Position | Jeffrey Geoghegan (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 8606793162 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Connecticut 263 Farmington Avenue Farmington CT 06030-5355 Ph: () - | State Of Connecticut 263 Farmington Avenue Farmington CT 06030-5355 Ph: (860) 679-2916 |
| NPI Number | 1669466561 |
|---|---|
| Provider Enumeration Date | 09/07/2005 |
| Last Update Date | 05/04/2023 |
| Certification Date | 12/15/2021 |
| Medicare PECOS PAC ID | 8022915677 |
|---|---|
| Medicare Enrollment ID | O20041122000596 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669466561 | NPI | - | NPPES |
| 4041968 | Medicaid | CT |
| Provider Name | Jill L Duboff-jacomini |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1538142435 PECOS PAC ID: 9638081763 Enrollment ID: I20031105000553 |
| Provider Name | Andrea B Moran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801897418 PECOS PAC ID: 0042105462 Enrollment ID: I20040216000931 |
| Provider Name | Abner S Gershon |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1114922812 PECOS PAC ID: 2668363326 Enrollment ID: I20040323000040 |
| Provider Name | Aleksandr Gorenbeyn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124026232 PECOS PAC ID: 3375536014 Enrollment ID: I20040407000627 |
| Provider Name | Thomas E Lawlor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780680702 PECOS PAC ID: 4587650585 Enrollment ID: I20040423001143 |
| Provider Name | Catherine F Lewis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275539488 PECOS PAC ID: 3779579669 Enrollment ID: I20040424000362 |
| Provider Name | Alberto Perez |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700971330 PECOS PAC ID: 2466436878 Enrollment ID: I20040615000145 |
| Provider Name | Michelle C Steele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578604666 PECOS PAC ID: 7911976675 Enrollment ID: I20040929000451 |
| Provider Name | Kelly K Johnson-arbor |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124061742 PECOS PAC ID: 5294798047 Enrollment ID: I20041111000743 |
| Provider Name | Lisa M Holme |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720042708 PECOS PAC ID: 5597720888 Enrollment ID: I20041129000488 |
| Provider Name | Caroline L Farnham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891888525 PECOS PAC ID: 5890750996 Enrollment ID: I20041201000048 |
| Provider Name | Meadow B Chen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255418828 PECOS PAC ID: 3072561216 Enrollment ID: I20050105000172 |
| Provider Name | William P Shea |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043217037 PECOS PAC ID: 4284686940 Enrollment ID: I20050210000909 |
| Provider Name | Andrew Winokur |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700883097 PECOS PAC ID: 1052363611 Enrollment ID: I20050211000597 |
| Provider Name | Jonathan M Covault |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619972395 PECOS PAC ID: 3476505033 Enrollment ID: I20050211000631 |
| Provider Name | Shawn R London |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1295733004 PECOS PAC ID: 8729033253 Enrollment ID: I20050317000771 |
| Provider Name | Linda A York |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1093710774 PECOS PAC ID: 6204874407 Enrollment ID: I20050419000781 |
| Provider Name | Douglas W Gibson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447245030 PECOS PAC ID: 4082656525 Enrollment ID: I20050525000640 |
| Provider Name | Elise R Kabela-cormier |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225036171 PECOS PAC ID: 9032152434 Enrollment ID: I20050607000447 |
| Provider Name | Julian D Ford |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083612477 PECOS PAC ID: 9133162548 Enrollment ID: I20050607000532 |
| Provider Name | Karen L Steinberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679571608 PECOS PAC ID: 9931143625 Enrollment ID: I20050614000524 |
| Provider Name | Norman J Andrekus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548268576 PECOS PAC ID: 4789629700 Enrollment ID: I20050621000687 |
| Provider Name | Denise Desimone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518312321 PECOS PAC ID: 8325077696 Enrollment ID: I20050808000014 |
| Provider Name | Jayesh R Kamath |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982604799 PECOS PAC ID: 0244262707 Enrollment ID: I20050906000403 |
| Provider Name | Heather L Sibley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992888069 PECOS PAC ID: 8729000286 Enrollment ID: I20051227000336 |
| Provider Name | Hynes M Birmingham |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124088711 PECOS PAC ID: 6103832381 Enrollment ID: I20060224000468 |
| Provider Name | Bipinchandra Jagjivan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619973823 PECOS PAC ID: 9032128962 Enrollment ID: I20060420000326 |
| Provider Name | John Y Yaylagul |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346289790 PECOS PAC ID: 6204848484 Enrollment ID: I20060707000309 |
| Provider Name | Maurice P Lee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285741025 PECOS PAC ID: 0244234813 Enrollment ID: I20060913000307 |
| Provider Name | Jill M Arcari-couture |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528044062 PECOS PAC ID: 5395743942 Enrollment ID: I20061122000038 |
| Provider Name | Heather Lee Spear |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1770542524 PECOS PAC ID: 9436157583 Enrollment ID: I20061128000108 |
| Provider Name | Surita Rao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437120821 PECOS PAC ID: 0547291353 Enrollment ID: I20070116000143 |
| Provider Name | Hannah M Bernard |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437292323 PECOS PAC ID: 3375643596 Enrollment ID: I20070717000168 |
| Provider Name | Janet Gillis-toffolo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972629475 PECOS PAC ID: 3274626213 Enrollment ID: I20070906000558 |
| Provider Name | Clifford K Yang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295730976 PECOS PAC ID: 8527152875 Enrollment ID: I20070918000523 |
| Provider Name | Ketan Bulsara |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1780888529 PECOS PAC ID: 5799746970 Enrollment ID: I20070919000678 |
| Provider Name | Kathleen Budnik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760673735 PECOS PAC ID: 6507951241 Enrollment ID: I20070926000984 |
| Provider Name | Francis B Lasala |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275547358 PECOS PAC ID: 7810083649 Enrollment ID: I20071010000035 |
| Provider Name | Carole P Maclellan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306031935 PECOS PAC ID: 9638267461 Enrollment ID: I20071113000219 |
| Provider Name | Margaret C Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902882533 PECOS PAC ID: 5496843021 Enrollment ID: I20071115000501 |
| Provider Name | Richard A Kamin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023016201 PECOS PAC ID: 7012098452 Enrollment ID: I20080111000250 |
| Provider Name | Adam D Corrado |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992769715 PECOS PAC ID: 9830118637 Enrollment ID: I20080128000026 |
| Provider Name | Sara A Blomstrom |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588786388 PECOS PAC ID: 4789768847 Enrollment ID: I20080227000720 |
| Provider Name | Diahann Wilcox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417954249 PECOS PAC ID: 9931279593 Enrollment ID: I20080609000416 |
| Provider Name | Folco Scappaticci |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962429746 PECOS PAC ID: 1254224397 Enrollment ID: I20080613000320 |
| Provider Name | Khalilah Hunter-anderson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508058512 PECOS PAC ID: 9830264654 Enrollment ID: I20080813000548 |
| Provider Name | Matthew Barr |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891992897 PECOS PAC ID: 6709951296 Enrollment ID: I20080818000774 |
| Provider Name | Alison L Luckey Percy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184893521 PECOS PAC ID: 3072673193 Enrollment ID: I20081119000714 |
| Provider Name | Kevin Gentile |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962610618 PECOS PAC ID: 2062565013 Enrollment ID: I20090808000114 |
| Provider Name | Robin Mary Zingales-browne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821229543 PECOS PAC ID: 3476609421 Enrollment ID: I20090924000646 |
| Provider Name | Peter A Cuniowski |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346222551 PECOS PAC ID: 1759456585 Enrollment ID: I20100624000256 |
| Provider Name | Alex Merkulov |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982868550 PECOS PAC ID: 6901939073 Enrollment ID: I20100727000740 |
| Provider Name | Danielle Mailloux Scott |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912084195 PECOS PAC ID: 8729111075 Enrollment ID: I20100806000320 |
| Provider Name | Meghan Herbst |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700083607 PECOS PAC ID: 6305961525 Enrollment ID: I20100911000069 |
| Provider Name | Electra V Kaloudis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811163678 PECOS PAC ID: 7517019409 Enrollment ID: I20100922000440 |
| Provider Name | Daniel Bg Freess |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992903447 PECOS PAC ID: 3577689033 Enrollment ID: I20100922000487 |
| Provider Name | Paul J Kaloudis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558566851 PECOS PAC ID: 4587756663 Enrollment ID: I20101021000485 |
| Provider Name | Craig Ryan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073581401 PECOS PAC ID: 8527253012 Enrollment ID: I20101110000320 |
| Provider Name | Robert P Fuller |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467450395 PECOS PAC ID: 1355307349 Enrollment ID: I20110111000632 |
| Provider Name | Genevieve C Oconnell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720092828 PECOS PAC ID: 3072702505 Enrollment ID: I20110113000784 |
| Provider Name | Thomas J Regan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053329565 PECOS PAC ID: 3678762150 Enrollment ID: I20110114000111 |
| Provider Name | Brian D Shames |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306898259 PECOS PAC ID: 6406846997 Enrollment ID: I20110321000410 |
| Provider Name | Joyce S Armstrong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881832327 PECOS PAC ID: 8022292705 Enrollment ID: I20110404000601 |
| Provider Name | Jessica R Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053632174 PECOS PAC ID: 8527245414 Enrollment ID: I20110601000525 |
| Provider Name | Marco Molina |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578761391 PECOS PAC ID: 6305023888 Enrollment ID: I20110609000475 |
| Provider Name | Matthew L Ledford |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659532638 PECOS PAC ID: 2567649908 Enrollment ID: I20110610000621 |
| Provider Name | Rochelle Renee Van Meter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619138567 PECOS PAC ID: 9739366188 Enrollment ID: I20110610000650 |
| Provider Name | Charan K Singh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1760620116 PECOS PAC ID: 4385830470 Enrollment ID: I20110727000151 |
| Provider Name | Alise Frallicciardi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144497801 PECOS PAC ID: 9335312198 Enrollment ID: I20111024000572 |
| Provider Name | Diana M Paez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518150010 PECOS PAC ID: 1456524834 Enrollment ID: I20111031000367 |
| Provider Name | Neha Jain |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255525747 PECOS PAC ID: 8527234046 Enrollment ID: I20120105000318 |
| Provider Name | Sarah M Merwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881980530 PECOS PAC ID: 7214191212 Enrollment ID: I20120601000458 |
| Provider Name | David C Steffens |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1669556536 PECOS PAC ID: 2860534963 Enrollment ID: I20120822000695 |
| Provider Name | Naila Azhar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477714376 PECOS PAC ID: 9931358058 Enrollment ID: I20121005000166 |
| Provider Name | Kristina F Zdanys |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063688679 PECOS PAC ID: 3476794710 Enrollment ID: I20130729000612 |
| Provider Name | Yu Liang |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1609036680 PECOS PAC ID: 6406090380 Enrollment ID: I20130916000021 |
| Provider Name | Michael T Baldwin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467529701 PECOS PAC ID: 6507921699 Enrollment ID: I20131118000915 |
| Provider Name | Beth Springate |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295172849 PECOS PAC ID: 2062652100 Enrollment ID: I20140124000061 |
| Provider Name | Nicole J Durante |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295177657 PECOS PAC ID: 9638309602 Enrollment ID: I20140313001504 |
| Provider Name | Christine Marie Demaio |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932383916 PECOS PAC ID: 0345473252 Enrollment ID: I20140430000915 |
| Provider Name | Asima A Zehgeer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437430683 PECOS PAC ID: 9931332517 Enrollment ID: I20140506001243 |
| Provider Name | David S Karimeddini |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528231677 PECOS PAC ID: 4486879095 Enrollment ID: I20140715000890 |
| Provider Name | Linda S Durst |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396718540 PECOS PAC ID: 4981590601 Enrollment ID: I20140801000201 |
| Provider Name | Kevin J Manning |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538576525 PECOS PAC ID: 4183844194 Enrollment ID: I20140925000515 |
| Provider Name | Faisal Ijaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336573146 PECOS PAC ID: 1355564675 Enrollment ID: I20150320000405 |
| Provider Name | Cristina Sanchez-torres |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801104872 PECOS PAC ID: 8426363409 Enrollment ID: I20150820009770 |
| Provider Name | Glenn Konopaske |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386613354 PECOS PAC ID: 3779474200 Enrollment ID: I20150921002268 |
| Provider Name | Shantay Wells |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952771651 PECOS PAC ID: 7012217854 Enrollment ID: I20151130000810 |
| Provider Name | Kipp Vanmeter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013145101 PECOS PAC ID: 6800113804 Enrollment ID: I20151201001261 |
| Provider Name | Elizabeth Connole-pond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346633435 PECOS PAC ID: 0840518320 Enrollment ID: I20160216000951 |
| Provider Name | Martha Jean Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598132581 PECOS PAC ID: 6204146376 Enrollment ID: I20160520000477 |
| Provider Name | Stephanie Paul |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932494697 PECOS PAC ID: 7012207756 Enrollment ID: I20160608001036 |
| Provider Name | Si Hyung Woo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497192413 PECOS PAC ID: 4082933635 Enrollment ID: I20160624000026 |
| Provider Name | Michael D Kisicki |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407067572 PECOS PAC ID: 0547394736 Enrollment ID: I20160729001467 |
| Provider Name | Daniel Marrero |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265743041 PECOS PAC ID: 4789998352 Enrollment ID: I20160809000731 |
| Provider Name | Christopher J Vetter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467899500 PECOS PAC ID: 1850610502 Enrollment ID: I20160913001679 |
| Provider Name | Karen A Bascetta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326479106 PECOS PAC ID: 7810284395 Enrollment ID: I20160927002057 |
| Provider Name | Kendra Damon-smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285189357 PECOS PAC ID: 0648567149 Enrollment ID: I20160927002878 |
| Provider Name | Luriza Glynn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487101465 PECOS PAC ID: 6800174160 Enrollment ID: I20161021000392 |
| Provider Name | Leo J Wolansky |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982793741 PECOS PAC ID: 5395632582 Enrollment ID: I20170323001182 |
| Provider Name | Angela O Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477092773 PECOS PAC ID: 0143506923 Enrollment ID: I20170410001453 |
| Provider Name | Natalie J Moore |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881011823 PECOS PAC ID: 3173749934 Enrollment ID: I20170706001891 |
| Provider Name | Matthew H Babcock |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952714198 PECOS PAC ID: 2264751734 Enrollment ID: I20170711003253 |
| Provider Name | Mario Caro Sabogal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679846109 PECOS PAC ID: 1557663895 Enrollment ID: I20170713001585 |
| Provider Name | Sarah Anh Nguyen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164781241 PECOS PAC ID: 8820369341 Enrollment ID: I20170802000747 |
| Provider Name | Eric Girard |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1588899405 PECOS PAC ID: 8729384169 Enrollment ID: I20170823001493 |
| Provider Name | Renee George |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982128138 PECOS PAC ID: 9133493851 Enrollment ID: I20170919003604 |
| Provider Name | Nadejda Maseto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376066043 PECOS PAC ID: 1052685575 Enrollment ID: I20170922000397 |
| Provider Name | Cassandra Holinka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730506767 PECOS PAC ID: 0941575898 Enrollment ID: I20171003007520 |
| Provider Name | Ryan Millea |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1427211457 PECOS PAC ID: 7618242447 Enrollment ID: I20171031002895 |
| Provider Name | Suzanne Doyon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477698264 PECOS PAC ID: 7315132933 Enrollment ID: I20171101001288 |
| Provider Name | Brian M Padilla |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790215093 PECOS PAC ID: 6901162338 Enrollment ID: I20171117000509 |
| Provider Name | Susan Rubman Gold |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992784128 PECOS PAC ID: 0941568935 Enrollment ID: I20171220003076 |
| Provider Name | Shakaib Naseem Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134561335 PECOS PAC ID: 4880956812 Enrollment ID: I20180402002019 |
| Provider Name | Salome Tsurtsumia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013411727 PECOS PAC ID: 7113282757 Enrollment ID: I20180531000888 |
| Provider Name | Jessica Potrepka Arsenault |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952899650 PECOS PAC ID: 2961757885 Enrollment ID: I20180618002717 |
| Provider Name | Jillian Lea Fortier |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1184945586 PECOS PAC ID: 0345599676 Enrollment ID: I20180821000645 |
| Provider Name | Tarannum Malwat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982192209 PECOS PAC ID: 5698027357 Enrollment ID: I20181008000488 |
| Provider Name | Keely Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437631041 PECOS PAC ID: 6901159920 Enrollment ID: I20181022001010 |
| Provider Name | Jonathan B Hargreaves |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457686156 PECOS PAC ID: 8820276264 Enrollment ID: I20181026001563 |
| Provider Name | Caitlin Marie Minihan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265923288 PECOS PAC ID: 7719230267 Enrollment ID: I20181030001978 |
| Provider Name | Angela Marie Virella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124505714 PECOS PAC ID: 3476898958 Enrollment ID: I20190103000903 |
| Provider Name | Aaron Sardell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952461477 PECOS PAC ID: 5092982785 Enrollment ID: I20190108001800 |
| Provider Name | Kwame S. Amankwah |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1508815762 PECOS PAC ID: 1759359755 Enrollment ID: I20190205001301 |
| Provider Name | Dhurga Devi Krishnamoorthy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295149607 PECOS PAC ID: 1850625104 Enrollment ID: I20190620002134 |
| Provider Name | Mario Fahed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548679525 PECOS PAC ID: 1456685338 Enrollment ID: I20190626002479 |
| Provider Name | Ruth J Hambrecht |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386007664 PECOS PAC ID: 3274827431 Enrollment ID: I20190715000120 |
| Provider Name | Meha Saxena |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962780502 PECOS PAC ID: 7012203391 Enrollment ID: I20190823000544 |
| Provider Name | Laura Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164823076 PECOS PAC ID: 6800196080 Enrollment ID: I20190830001693 |
| Provider Name | Chijioke Nnanna Egbujo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164601548 PECOS PAC ID: 9830484005 Enrollment ID: I20191003000663 |
| Provider Name | Jessica Kluewer-damico |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497282578 PECOS PAC ID: 9234563503 Enrollment ID: I20191218002930 |
| Provider Name | Judith L Cooney |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841301827 PECOS PAC ID: 9032530852 Enrollment ID: I20200603002671 |
| Provider Name | Gregory Charles Barron |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770946030 PECOS PAC ID: 6305130642 Enrollment ID: I20200707002736 |
| Provider Name | Brady Lonergan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548654080 PECOS PAC ID: 7214244938 Enrollment ID: I20200717001343 |
| Provider Name | Babitha Mathew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508491853 PECOS PAC ID: 7911325113 Enrollment ID: I20200921002593 |
| Provider Name | Michael Mei |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700373883 PECOS PAC ID: 8729337217 Enrollment ID: I20201202002882 |
| Provider Name | Cutter Augustus Lindbergh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801490040 PECOS PAC ID: 1557770856 Enrollment ID: I20210517000774 |
| Provider Name | Edward K Afful |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942834049 PECOS PAC ID: 3779909338 Enrollment ID: I20210616001024 |
| Provider Name | Johnathan Lee Nieves |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275039067 PECOS PAC ID: 5597013664 Enrollment ID: I20210628001555 |
| Provider Name | Venkat Subramanyam |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437681434 PECOS PAC ID: 6305118530 Enrollment ID: I20210630002132 |
| Provider Name | Caleb Battersby |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033642145 PECOS PAC ID: 2567733959 Enrollment ID: I20210929001366 |
| Provider Name | Furne Susan Carrier-valentine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366935876 PECOS PAC ID: 4880082999 Enrollment ID: I20211022000149 |
| Provider Name | Sarah Napuli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306595731 PECOS PAC ID: 8527455930 Enrollment ID: I20220503000603 |
| Provider Name | Feier Liu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104358977 PECOS PAC ID: 5395015192 Enrollment ID: I20220617001784 |
| Provider Name | Ashleigh Frank |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1679954697 PECOS PAC ID: 6507152873 Enrollment ID: I20220809001374 |
| Provider Name | Lauren Strainge |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801529052 PECOS PAC ID: 1759764434 Enrollment ID: I20220812000846 |
| Provider Name | Lauren Bacon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972065613 PECOS PAC ID: 3375927395 Enrollment ID: I20220825000124 |
| Provider Name | Sobia Faisal |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1174056881 PECOS PAC ID: 8729350921 Enrollment ID: I20220831000672 |
| Provider Name | Andrea M Montilla Santiago |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811493232 PECOS PAC ID: 0648529347 Enrollment ID: I20220928003627 |
| Provider Name | Gary Gong |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154373157 PECOS PAC ID: 2668451154 Enrollment ID: I20221021001089 |
| Provider Name | Nectarios Chris Bonatsakis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023472974 PECOS PAC ID: 7911375548 Enrollment ID: I20221201001619 |
| Provider Name | Nadia Pare |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548435670 PECOS PAC ID: 4385794023 Enrollment ID: I20230531001105 |
| Provider Name | Ryan James Sorkin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134758675 PECOS PAC ID: 1658739081 Enrollment ID: I20230616001683 |
| Provider Name | Sarah Kwok |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518452234 PECOS PAC ID: 7315296019 Enrollment ID: I20230626002557 |
| Provider Name | Katie Rong |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770043770 PECOS PAC ID: 8325378524 Enrollment ID: I20231013003107 |
| Provider Name | Caroline Lloyd |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104448513 PECOS PAC ID: 2062831670 Enrollment ID: I20231115001902 |
| Provider Name | Dia O'brien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750168951 PECOS PAC ID: 1456796424 Enrollment ID: I20240229001174 |
| Provider Name | Kimberly Ann Santora |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477856078 PECOS PAC ID: 6608214333 Enrollment ID: I20240401002051 |
| Provider Name | Jessica Silverman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902522964 PECOS PAC ID: 8325487028 Enrollment ID: I20240415001123 |
| Provider Name | Kelsey E. Boyne |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508499435 PECOS PAC ID: 7719421668 Enrollment ID: I20240702002182 |
| Provider Name | Marleni Milla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215433982 PECOS PAC ID: 3274882634 Enrollment ID: I20240908000061 |
| Provider Name | Cathryn Glanton Holzhauer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1154840668 PECOS PAC ID: 1759814593 Enrollment ID: I20241031002047 |
| Provider Name | Mariam Zacharias |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215752431 PECOS PAC ID: 1052832219 Enrollment ID: I20250305000832 |
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