| Oak Street Health Vista Grande | |
|
4380 Austin Bluffs Pkwy Colorado Springs CO 80918-2932 | |
| (719) 454-6009 | |
| (719) 258-1319 |
| Full Name | Oak Street Health Vista Grande |
|---|---|
| Speciality | Clinic/Center |
| Location | 4380 Austin Bluffs Pkwy, Colorado Springs, Colorado |
| Authorized Official Name and Position | Griffin Myers (CMO) |
| Authorized Official Contact | 3072642085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oak Street Health Vista Grande Po Box 746081 Atlanta GA 30374-6081 Ph: (312) 733-9730 | Oak Street Health Vista Grande 4380 Austin Bluffs Pkwy Colorado Springs CO 80918-2932 Ph: (719) 454-6009 |
| NPI Number | 1134868599 |
|---|---|
| Provider Enumeration Date | 06/02/2022 |
| Last Update Date | 06/30/2023 |
| Certification Date | 06/30/2023 |
| Medicare PECOS PAC ID | 9032585054 |
|---|---|
| Medicare Enrollment ID | O20221017001648 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134868599 | NPI | - | NPPES |
| Provider Name | Linda Marie Hewett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952334989 PECOS PAC ID: 0143283895 Enrollment ID: I20041104000637 |
| Provider Name | Jennifer A Ziouras |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619976099 PECOS PAC ID: 2860306842 Enrollment ID: I20051028000482 |
| Provider Name | Grace D Ortega-walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043363294 PECOS PAC ID: 2365542867 Enrollment ID: I20070712000827 |
| Provider Name | Janel J Moreno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346260320 PECOS PAC ID: 2668377490 Enrollment ID: I20140904001164 |
| Provider Name | Teresa K. Tanabe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861895807 PECOS PAC ID: 7113235623 Enrollment ID: I20151002001402 |
| Provider Name | Che Kheng Pang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306365804 PECOS PAC ID: 5799050571 Enrollment ID: I20171004001180 |
| Provider Name | Taylor Nicole Knese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235605007 PECOS PAC ID: 5092051466 Enrollment ID: I20190107003065 |
| Provider Name | Carolyn Shay Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881821296 PECOS PAC ID: 4587809454 Enrollment ID: I20190717003958 |
| Provider Name | Jessica Irene Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225635238 PECOS PAC ID: 8022421866 Enrollment ID: I20210115000849 |
| Provider Name | Kelsea Hough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861129892 PECOS PAC ID: 9638553431 Enrollment ID: I20220829000177 |
| Provider Name | Sara Konopka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205561529 PECOS PAC ID: 2668856402 Enrollment ID: I20220829001951 |
| Provider Name | Michele Mitchell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174505325 PECOS PAC ID: 9234215401 Enrollment ID: I20221017001808 |
| Provider Name | Erik Wallace |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477523843 PECOS PAC ID: 7113829128 Enrollment ID: I20221018000932 |
| Provider Name | Mekael Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932446952 PECOS PAC ID: 1052633245 Enrollment ID: I20221104000452 |
| Provider Name | Haydn Jessup |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881056802 PECOS PAC ID: 3375910839 Enrollment ID: I20221114000810 |
| Provider Name | Natalia Klusacek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497142285 PECOS PAC ID: 1759686660 Enrollment ID: I20221208000046 |
| Provider Name | Archana Kayastha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437628567 PECOS PAC ID: 3375877459 Enrollment ID: I20221227000493 |
| Provider Name | Justin Hunt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326138074 PECOS PAC ID: 6901842228 Enrollment ID: I20221228000795 |
| Provider Name | Leyna Inberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801255898 PECOS PAC ID: 9830498138 Enrollment ID: I20230601002829 |
| Provider Name | Cindy Suthar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750815981 PECOS PAC ID: 6204113194 Enrollment ID: I20230804000954 |
| Provider Name | Hyojeong Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790433910 PECOS PAC ID: 0648653048 Enrollment ID: I20230823002709 |
| Provider Name | Alden Zwerling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316987852 PECOS PAC ID: 1759351877 Enrollment ID: I20231010003015 |
| Provider Name | Lauren Hope Swanner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912682964 PECOS PAC ID: 2567817539 Enrollment ID: I20231011001144 |
| Provider Name | Gregory Paul Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417730425 PECOS PAC ID: 4688021280 Enrollment ID: I20231102004029 |
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