| Aspirus Elcho Clinic | |
|
W10618 Clinic St Elcho WI 54428-9619 | |
| (715) 275-4011 | |
| Not Available |
| Full Name | Aspirus Elcho Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | W10618 Clinic St, Elcho, Wisconsin |
| Authorized Official Name and Position | Pat Tincher (VP COO) |
| Authorized Official Contact | 7156232351 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aspirus Elcho Clinic Po Box 87 Antigo WI 54409-0087 Ph: (715) 623-2351 | Aspirus Elcho Clinic W10618 Clinic St Elcho WI 54428-9619 Ph: (715) 275-4011 |
| NPI Number | 1831251040 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 11/10/2022 |
| Medicare PECOS PAC ID | 1557271202 |
|---|---|
| Medicare Enrollment ID | O20040212000310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831251040 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (Wisconsin) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Kshamata Shalini |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023099306 PECOS PAC ID: 0840196036 Enrollment ID: I20031209000630 |
| Provider Name | Kathleen M Hargarten |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205803947 PECOS PAC ID: 6305739186 Enrollment ID: I20040205000444 |
| Provider Name | Stephen W. Hubbard |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366434961 PECOS PAC ID: 6002705811 Enrollment ID: I20040311000344 |
| Provider Name | Richard J Mayrer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023047859 PECOS PAC ID: 7810977717 Enrollment ID: I20040721001565 |
| Provider Name | Rita L Stowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770508863 PECOS PAC ID: 8224000542 Enrollment ID: I20040809000242 |
| Provider Name | Bonnie J Hessedal |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1023233822 PECOS PAC ID: 7416921929 Enrollment ID: I20040820001045 |
| Provider Name | Cary G Tauchman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891800389 PECOS PAC ID: 7719954197 Enrollment ID: I20040915000028 |
| Provider Name | Mary Anderson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1487662060 PECOS PAC ID: 1052210762 Enrollment ID: I20040927000962 |
| Provider Name | Ellyn M Meshel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205875242 PECOS PAC ID: 9335114024 Enrollment ID: I20041008000009 |
| Provider Name | David D Vanderkin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962407197 PECOS PAC ID: 3779486030 Enrollment ID: I20050106000937 |
| Provider Name | Renee M Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750310900 PECOS PAC ID: 9537117296 Enrollment ID: I20050110000337 |
| Provider Name | Rebecca Reim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043211766 PECOS PAC ID: 2668416744 Enrollment ID: I20050620000605 |
| Provider Name | Christopher Gary Peterson |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1700897535 PECOS PAC ID: 8820024474 Enrollment ID: I20050714000500 |
| Provider Name | Bart R Kneeland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265466296 PECOS PAC ID: 5395773048 Enrollment ID: I20050803000064 |
| Provider Name | Kristine E Flowers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669405676 PECOS PAC ID: 9830127588 Enrollment ID: I20050803000077 |
| Provider Name | Robert A Selden |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1427086875 PECOS PAC ID: 5890747356 Enrollment ID: I20050916000474 |
| Provider Name | Kasra A Milani |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1124089750 PECOS PAC ID: 7911927306 Enrollment ID: I20051130000446 |
| Provider Name | Kristen M Wells |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1780642397 PECOS PAC ID: 0840212585 Enrollment ID: I20051222000310 |
| Provider Name | Noel N Deep |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467470864 PECOS PAC ID: 7810904240 Enrollment ID: I20060309000621 |
| Provider Name | Carlos X Condado |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1205028768 PECOS PAC ID: 2860478690 Enrollment ID: I20060313000396 |
| Provider Name | Robert R Kohl |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1689628901 PECOS PAC ID: 7214948561 Enrollment ID: I20060526000087 |
| Provider Name | Christian Degregorio |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184676827 PECOS PAC ID: 4486665544 Enrollment ID: I20060606000075 |
| Provider Name | Nicole L Wade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497714406 PECOS PAC ID: 3173536703 Enrollment ID: I20060726000057 |
| Provider Name | Richard A Olson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1336145093 PECOS PAC ID: 9638192321 Enrollment ID: I20060829000046 |
| Provider Name | Kathleen A Freeland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710094123 PECOS PAC ID: 1850397118 Enrollment ID: I20061010000057 |
| Provider Name | Debra A Safford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063512382 PECOS PAC ID: 6002813698 Enrollment ID: I20061024000278 |
| Provider Name | Lakshmi Deep |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336172303 PECOS PAC ID: 1456361963 Enrollment ID: I20070209000318 |
| Provider Name | Corina J Norrbom |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982637914 PECOS PAC ID: 1759484892 Enrollment ID: I20070312000098 |
| Provider Name | Gregory C Tyler |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871695452 PECOS PAC ID: 3971603176 Enrollment ID: I20070717000010 |
| Provider Name | Peter M Mccool |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306044847 PECOS PAC ID: 3274620133 Enrollment ID: I20071025000076 |
| Provider Name | Diane L Reetz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942497185 PECOS PAC ID: 4688762511 Enrollment ID: I20071110000133 |
| Provider Name | Jeffrey M Vanbendegom |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477544427 PECOS PAC ID: 9436248002 Enrollment ID: I20071204000806 |
| Provider Name | Michael A Umland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518920578 PECOS PAC ID: 2062593023 Enrollment ID: I20080115000827 |
| Provider Name | Mitchell L Lewis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912956137 PECOS PAC ID: 3870686462 Enrollment ID: I20080222000358 |
| Provider Name | Corey L Slominski |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1841491875 PECOS PAC ID: 4587740444 Enrollment ID: I20080318000769 |
| Provider Name | Gregory G Dodge |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1497857171 PECOS PAC ID: 2062583883 Enrollment ID: I20080620000451 |
| Provider Name | Thomas W Tully |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1851369664 PECOS PAC ID: 6709847874 Enrollment ID: I20080919000462 |
| Provider Name | Susanne J Schaars |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1942381488 PECOS PAC ID: 5294802476 Enrollment ID: I20080930000648 |
| Provider Name | Kelly B Jankowsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952550576 PECOS PAC ID: 3173691102 Enrollment ID: I20081003000731 |
| Provider Name | Melissa L Ferg |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1982869434 PECOS PAC ID: 5193886471 Enrollment ID: I20081204000670 |
| Provider Name | Robert K Lee |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437119781 PECOS PAC ID: 8022192178 Enrollment ID: I20090306000344 |
| Provider Name | Michael P Bellino |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780670950 PECOS PAC ID: 1153224431 Enrollment ID: I20090602000566 |
| Provider Name | Christian Zuver |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194843367 PECOS PAC ID: 5890887830 Enrollment ID: I20090624000126 |
| Provider Name | Barbara L Rothweiler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376544247 PECOS PAC ID: 8426100256 Enrollment ID: I20090709000049 |
| Provider Name | Susan Frangiskakis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932172053 PECOS PAC ID: 9032123591 Enrollment ID: I20090722000611 |
| Provider Name | Michael D Repplinger |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154521425 PECOS PAC ID: 5294872693 Enrollment ID: I20091016000136 |
| Provider Name | Michael D Polka |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144242223 PECOS PAC ID: 3072654425 Enrollment ID: I20100106000782 |
| Provider Name | James E Svenson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700847183 PECOS PAC ID: 5698805455 Enrollment ID: I20100604001133 |
| Provider Name | Lonna L Grosskopf |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1003856618 PECOS PAC ID: 4284765116 Enrollment ID: I20100621000934 |
| Provider Name | Michael C Walters |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063473973 PECOS PAC ID: 1456482017 Enrollment ID: I20100625000120 |
| Provider Name | Diane M Mansfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023115219 PECOS PAC ID: 3072645027 Enrollment ID: I20100709000805 |
| Provider Name | Adetunji A Adejumo |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1942532528 PECOS PAC ID: 9638294986 Enrollment ID: I20100910000295 |
| Provider Name | Dennis Mcfadden |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1184758237 PECOS PAC ID: 2961580717 Enrollment ID: I20101004000991 |
| Provider Name | Shefiu O Shittu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1154646727 PECOS PAC ID: 5799977401 Enrollment ID: I20101012001243 |
| Provider Name | Okechukwu N Kanu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1871817593 PECOS PAC ID: 1850584772 Enrollment ID: I20101022000966 |
| Provider Name | William Y Ansa Otu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346564168 PECOS PAC ID: 2365635208 Enrollment ID: I20101022001131 |
| Provider Name | Ruth Mahmood |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1659518199 PECOS PAC ID: 9234322900 Enrollment ID: I20101026000991 |
| Provider Name | Anna Kathryn Olson |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1790992295 PECOS PAC ID: 7214122050 Enrollment ID: I20101105001271 |
| Provider Name | Larry R Brunzlick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770646721 PECOS PAC ID: 4385832344 Enrollment ID: I20101217000680 |
| Provider Name | Carl J Viviano |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1811925829 PECOS PAC ID: 0244142834 Enrollment ID: I20110114000960 |
| Provider Name | Joseph W Babiarz |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1962446476 PECOS PAC ID: 4284823634 Enrollment ID: I20110114001090 |
| Provider Name | Patrick A Mckenna |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831358142 PECOS PAC ID: 0941487359 Enrollment ID: I20110613000612 |
| Provider Name | Jennifer J Friday |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568750834 PECOS PAC ID: 0941478317 Enrollment ID: I20110729000631 |
| Provider Name | Daniel S Skeen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487942694 PECOS PAC ID: 6608046404 Enrollment ID: I20110906000343 |
| Provider Name | Tanya B Lechtev |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245498005 PECOS PAC ID: 2264563832 Enrollment ID: I20110912000158 |
| Provider Name | Steven P Phillipson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023034105 PECOS PAC ID: 0345141313 Enrollment ID: I20110923000055 |
| Provider Name | Michael E Traktman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356325740 PECOS PAC ID: 6406820513 Enrollment ID: I20111004000296 |
| Provider Name | Lance M Kelly |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1689959777 PECOS PAC ID: 0446426993 Enrollment ID: I20120104000476 |
| Provider Name | Andrew D Snider |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659548584 PECOS PAC ID: 4284770439 Enrollment ID: I20120614000125 |
| Provider Name | Trina M Daniels |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578706073 PECOS PAC ID: 7618132804 Enrollment ID: I20120713000579 |
| Provider Name | Marc D Biedermann |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912131699 PECOS PAC ID: 0547416547 Enrollment ID: I20120807000591 |
| Provider Name | Cody A Nikolai |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1295952539 PECOS PAC ID: 6901052695 Enrollment ID: I20120813000402 |
| Provider Name | Vimarsh Raina |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508177841 PECOS PAC ID: 9537315064 Enrollment ID: I20120815000587 |
| Provider Name | Niaz M Haque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871783407 PECOS PAC ID: 9234271107 Enrollment ID: I20120917000455 |
| Provider Name | Timothy E Wasano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982959391 PECOS PAC ID: 1658356175 Enrollment ID: I20121012000317 |
| Provider Name | Katie B Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568714723 PECOS PAC ID: 7315198603 Enrollment ID: I20121114000432 |
| Provider Name | Kyle J Hunter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154648020 PECOS PAC ID: 3274788583 Enrollment ID: I20130312000140 |
| Provider Name | Joseph F Ponik |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1619214152 PECOS PAC ID: 5597900613 Enrollment ID: I20130320000618 |
| Provider Name | Coy H Johnston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720371321 PECOS PAC ID: 9537112545 Enrollment ID: I20130321000458 |
| Provider Name | Ashley E St Clair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598035768 PECOS PAC ID: 7911143110 Enrollment ID: I20130412000444 |
| Provider Name | Christopher S Platta |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1811127301 PECOS PAC ID: 6305083312 Enrollment ID: I20130511000060 |
| Provider Name | Olga Barchugova |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750562617 PECOS PAC ID: 2567658388 Enrollment ID: I20130709000716 |
| Provider Name | Michael J Olson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891062592 PECOS PAC ID: 0941466585 Enrollment ID: I20130806000324 |
| Provider Name | Nicole M Wolfgram |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447593454 PECOS PAC ID: 9931333119 Enrollment ID: I20131001000043 |
| Provider Name | Douglas R Brown |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1992784904 PECOS PAC ID: 5597866863 Enrollment ID: I20131009000266 |
| Provider Name | Liova E Rivera-garcia |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790712610 PECOS PAC ID: 2062420318 Enrollment ID: I20131009000994 |
| Provider Name | Jiannan Zhang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366875338 PECOS PAC ID: 5294961330 Enrollment ID: I20131120001741 |
| Provider Name | Helen Blanch Cueny |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720003999 PECOS PAC ID: 7618981838 Enrollment ID: I20131202001573 |
| Provider Name | Adam G Clements |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033477997 PECOS PAC ID: 0749419778 Enrollment ID: I20140214000951 |
| Provider Name | Michele Prevost |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1700877875 PECOS PAC ID: 9032262670 Enrollment ID: I20140310002024 |
| Provider Name | Matthew J Koeberl |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396975165 PECOS PAC ID: 1254555774 Enrollment ID: I20140624000090 |
| Provider Name | Ridhwi Mukerji |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1366735755 PECOS PAC ID: 5698990364 Enrollment ID: I20140714001681 |
| Provider Name | Andrea Beth Jolley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154301463 PECOS PAC ID: 2668377656 Enrollment ID: I20141110001776 |
| Provider Name | Jennifer J Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831530583 PECOS PAC ID: 4688899552 Enrollment ID: I20150218000270 |
| Provider Name | Kris Ferguson |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1376751271 PECOS PAC ID: 1658422480 Enrollment ID: I20150226001814 |
| Provider Name | Jennifer Jean Delaney |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1992733166 PECOS PAC ID: 2365493061 Enrollment ID: I20150320001396 |
| Provider Name | Jennifer I Jordan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255739470 PECOS PAC ID: 1850618901 Enrollment ID: I20150330000620 |
| Provider Name | Nicole K Rice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831582436 PECOS PAC ID: 3476872896 Enrollment ID: I20150507000572 |
| Provider Name | Vicki L Maguire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215328794 PECOS PAC ID: 7315266467 Enrollment ID: I20150512001577 |
| Provider Name | Kyle Dembowiak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235499815 PECOS PAC ID: 7517271539 Enrollment ID: I20150805006698 |
| Provider Name | Jayanna Lynn Volm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619358678 PECOS PAC ID: 8224344866 Enrollment ID: I20150827002457 |
| Provider Name | Jeffrey E Ilsley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194703991 PECOS PAC ID: 8628037207 Enrollment ID: I20150914000152 |
| Provider Name | Herbert C Hoover |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1386683613 PECOS PAC ID: 0648262790 Enrollment ID: I20160203002363 |
| Provider Name | Daniel Eric Salinsky |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649400227 PECOS PAC ID: 7911154745 Enrollment ID: I20160426000326 |
| Provider Name | Aaron M Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568911097 PECOS PAC ID: 5799063343 Enrollment ID: I20161102000345 |
| Provider Name | Kara Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225403769 PECOS PAC ID: 3870877210 Enrollment ID: I20170301002669 |
| Provider Name | David Bingham |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1831393628 PECOS PAC ID: 7911186549 Enrollment ID: I20170505000850 |
| Provider Name | Michael A Ward |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316279433 PECOS PAC ID: 5294901526 Enrollment ID: I20170706000889 |
| Provider Name | Efe M Akpoigbe |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1023365152 PECOS PAC ID: 9032334891 Enrollment ID: I20170719003840 |
| Provider Name | Todd M Andres |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588846497 PECOS PAC ID: 7012282247 Enrollment ID: I20171013001117 |
| Provider Name | Jappan J Bhatt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669594115 PECOS PAC ID: 2567562952 Enrollment ID: I20171026001437 |
| Provider Name | Sara Starr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518471838 PECOS PAC ID: 2264790203 Enrollment ID: I20171220000408 |
| Provider Name | Daniel Eggeman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336568450 PECOS PAC ID: 5799085544 Enrollment ID: I20180411000255 |
| Provider Name | Benjamin J Graboyes |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720424807 PECOS PAC ID: 2264723519 Enrollment ID: I20180615000361 |
| Provider Name | Ahmed Mohammed |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1407231178 PECOS PAC ID: 1557619913 Enrollment ID: I20180801004049 |
| Provider Name | Katie E Vangoethem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760962393 PECOS PAC ID: 7012267958 Enrollment ID: I20180913002198 |
| Provider Name | Courtney L Mattek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982181913 PECOS PAC ID: 4688925472 Enrollment ID: I20180918001172 |
| Provider Name | Christina L Leslie |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114328960 PECOS PAC ID: 3577817675 Enrollment ID: I20181108000071 |
| Provider Name | Brittany K Santiago |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275000259 PECOS PAC ID: 3072859966 Enrollment ID: I20190115000057 |
| Provider Name | Richard C Prokesch |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1427064583 PECOS PAC ID: 2668411570 Enrollment ID: I20190319000054 |
| Provider Name | Jennifer J Schmidt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184180994 PECOS PAC ID: 7517208879 Enrollment ID: I20190415001148 |
| Provider Name | Shirin Sultana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053610691 PECOS PAC ID: 7416266846 Enrollment ID: I20190423001599 |
| Provider Name | Sara A Pavelski |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1851738397 PECOS PAC ID: 6002159480 Enrollment ID: I20190529000633 |
| Provider Name | Cassie S Jentges |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1912564485 PECOS PAC ID: 3870827280 Enrollment ID: I20190618003219 |
| Provider Name | Jamie Lynn Schneider |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801240858 PECOS PAC ID: 3072877364 Enrollment ID: I20190711002059 |
| Provider Name | Rachael E Miller |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1487218400 PECOS PAC ID: 1355677436 Enrollment ID: I20190726001817 |
| Provider Name | Roshini A Samuel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548612922 PECOS PAC ID: 8224365176 Enrollment ID: I20190815000037 |
| Provider Name | Shane D Franklin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417301631 PECOS PAC ID: 2961730718 Enrollment ID: I20190819001394 |
| Provider Name | Dorene Zerfas |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1427299973 PECOS PAC ID: 1759519549 Enrollment ID: I20190909002185 |
| Provider Name | Kelly Jonathon Douck |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1447807086 PECOS PAC ID: 6305177429 Enrollment ID: I20191003002525 |
| Provider Name | Melissa M Jensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295381481 PECOS PAC ID: 4789915752 Enrollment ID: I20191007001981 |
| Provider Name | Calla J Scheel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417599804 PECOS PAC ID: 5698107613 Enrollment ID: I20191113002019 |
| Provider Name | Nathan D Mcparlan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073656955 PECOS PAC ID: 3173680089 Enrollment ID: I20200207000002 |
| Provider Name | Andrew Huang |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1679957526 PECOS PAC ID: 7113256025 Enrollment ID: I20200610000620 |
| Provider Name | Thomas C Howard |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1932369584 PECOS PAC ID: 0749583706 Enrollment ID: I20200610001054 |
| Provider Name | Justin Teresinski |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1134615131 PECOS PAC ID: 1153679048 Enrollment ID: I20200618000908 |
| Provider Name | Amy Jeanne Defranco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962045393 PECOS PAC ID: 2466697842 Enrollment ID: I20200713000588 |
| Provider Name | Johonna Asquith |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1730447400 PECOS PAC ID: 5395986848 Enrollment ID: I20200720000195 |
| Provider Name | Colleen E Lane |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1659717312 PECOS PAC ID: 3779722251 Enrollment ID: I20200814002130 |
| Provider Name | Syed M Imam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699202408 PECOS PAC ID: 8527339514 Enrollment ID: I20200917001379 |
| Provider Name | Susan Acuna |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720030893 PECOS PAC ID: 8527056340 Enrollment ID: I20200922002401 |
| Provider Name | Justin Asquith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699031138 PECOS PAC ID: 1052603636 Enrollment ID: I20200925001250 |
| Provider Name | Nicholas Robert Rydzewski |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1568855161 PECOS PAC ID: 5193075240 Enrollment ID: I20201009000156 |
| Provider Name | Jordan Knopf |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588015465 PECOS PAC ID: 1759701402 Enrollment ID: I20201019000687 |
| Provider Name | Waleed Mansour |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043628589 PECOS PAC ID: 1557661980 Enrollment ID: I20201210002640 |
| Provider Name | Patrick O Odia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285041285 PECOS PAC ID: 0547530859 Enrollment ID: I20201216001494 |
| Provider Name | Evon Louise Schexnaydre |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386603561 PECOS PAC ID: 8325052061 Enrollment ID: I20201222000551 |
| Provider Name | Nancy A Rihana |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1982835237 PECOS PAC ID: 5294954699 Enrollment ID: I20210201000594 |
| Provider Name | John Pietila |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841450772 PECOS PAC ID: 9133353014 Enrollment ID: I20210215000943 |
| Provider Name | Alaina Below |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750931481 PECOS PAC ID: 6406263060 Enrollment ID: I20210325002754 |
| Provider Name | Emily C. Merfeld |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1194222554 PECOS PAC ID: 4486901683 Enrollment ID: I20210407001145 |
| Provider Name | Srikar Karanam |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588034227 PECOS PAC ID: 5092074302 Enrollment ID: I20210615003299 |
| Provider Name | Jalel Abera Hunde |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194220558 PECOS PAC ID: 5597167569 Enrollment ID: I20210713003344 |
| Provider Name | Shaun Raganyi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710482229 PECOS PAC ID: 1850716192 Enrollment ID: I20210728003225 |
| Provider Name | Tom T Chen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1922389048 PECOS PAC ID: 0941578736 Enrollment ID: I20210813001496 |
| Provider Name | Emmanuel Trigenis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225011844 PECOS PAC ID: 7719074319 Enrollment ID: I20210831002964 |
| Provider Name | Miranda Emily Copa |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1992377691 PECOS PAC ID: 6709283880 Enrollment ID: I20210916002926 |
| Provider Name | Anna M Brown |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1972966125 PECOS PAC ID: 8628349222 Enrollment ID: I20210929002662 |
| Provider Name | Nathan John Walters |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730281312 PECOS PAC ID: 1254366933 Enrollment ID: I20211007003223 |
| Provider Name | Maxwell Henricks |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578927547 PECOS PAC ID: 0941547301 Enrollment ID: I20211109003207 |
| Provider Name | Danielle Espe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750985453 PECOS PAC ID: 3577975176 Enrollment ID: I20211130003075 |
| Provider Name | Angela Haroldson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467121681 PECOS PAC ID: 1052701240 Enrollment ID: I20211202000156 |
| Provider Name | Fernando Escobar |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1548265994 PECOS PAC ID: 0648294884 Enrollment ID: I20220119001339 |
| Provider Name | Sonny Park |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720071277 PECOS PAC ID: 2264443233 Enrollment ID: I20220621001207 |
| Provider Name | Ross Trecartin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205495694 PECOS PAC ID: 6507249125 Enrollment ID: I20220815003118 |
| Provider Name | Gail Marion Marquardt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609503085 PECOS PAC ID: 0941684252 Enrollment ID: I20220906003137 |
| Provider Name | Jeffrey L Johnson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1235115064 PECOS PAC ID: 2860415593 Enrollment ID: I20220909001074 |
| Provider Name | Monica Cespedes Santana |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114204161 PECOS PAC ID: 7214212653 Enrollment ID: I20221008000304 |
| Provider Name | Carole Vincent |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1497731038 PECOS PAC ID: 9830131994 Enrollment ID: I20221103000709 |
| Provider Name | Katie Seybold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629793948 PECOS PAC ID: 5698143345 Enrollment ID: I20221130001676 |
| Provider Name | Carmen Krug |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1407428121 PECOS PAC ID: 7810366812 Enrollment ID: I20221214001803 |
| Provider Name | Mitchell T Meagher |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932621307 PECOS PAC ID: 2668842014 Enrollment ID: I20221230000838 |
| Provider Name | David Slobodkin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194795591 PECOS PAC ID: 3678545928 Enrollment ID: I20230104003063 |
| Provider Name | Ravindran Arcot Padmanabhan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730114943 PECOS PAC ID: 5799727616 Enrollment ID: I20230302001458 |
| Provider Name | Tyler Volovsek |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1639838642 PECOS PAC ID: 4587029699 Enrollment ID: I20230425001133 |
| Provider Name | Andrea Caballero |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003173824 PECOS PAC ID: 3274841770 Enrollment ID: I20230428001880 |
| Provider Name | Molly Marie Blemke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306546866 PECOS PAC ID: 0840656096 Enrollment ID: I20230515001609 |
| Provider Name | Elizabeth O Wendt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821784067 PECOS PAC ID: 3870959513 Enrollment ID: I20230522003253 |
| Provider Name | Christopher L Smith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629028782 PECOS PAC ID: 6901790252 Enrollment ID: I20230524003086 |
| Provider Name | Patrick H Archie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982895835 PECOS PAC ID: 0749355543 Enrollment ID: I20230602000332 |
| Provider Name | Tian Xia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437357423 PECOS PAC ID: 2961681713 Enrollment ID: I20230602002603 |
| Provider Name | Tiffany Justine Krusick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861197667 PECOS PAC ID: 5395103238 Enrollment ID: I20230624000180 |
| Provider Name | Thomas Oliver |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083069470 PECOS PAC ID: 9739477324 Enrollment ID: I20230711001880 |
| Provider Name | Richard Belt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275064263 PECOS PAC ID: 1850643115 Enrollment ID: I20230731000081 |
| Provider Name | Carina Lea Hafner |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407284417 PECOS PAC ID: 8426411604 Enrollment ID: I20230906001205 |
| Provider Name | Tatyana Bombard |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255629861 PECOS PAC ID: 0941595748 Enrollment ID: I20230911001645 |
| Provider Name | Annika Grace Fox |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1033994702 PECOS PAC ID: 6204280324 Enrollment ID: I20230922003282 |
| Provider Name | Katy Lynn Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295412815 PECOS PAC ID: 8527412295 Enrollment ID: I20230928002772 |
| Provider Name | Adrienne Stevenson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1497020697 PECOS PAC ID: 8426346958 Enrollment ID: I20240126002659 |
| Provider Name | Angela Joy Filbrandt-sheldon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194591628 PECOS PAC ID: 0042663940 Enrollment ID: I20240126002940 |