| Beacon Medical Group, Inc. | |
|
4630 Vistula Rd Mishawaka IN 46544-4000 | |
| (574) 647-1900 | |
| (574) 254-7222 |
| Full Name | Beacon Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 4630 Vistula Rd, Mishawaka, Indiana |
| Authorized Official Name and Position | Jeffrey Costello (VP-CFO) |
| Authorized Official Contact | 5746473549 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Medical Group, Inc. 3245 Health Dr Ste 100 Granger IN 46530-1380 Ph: (574) 647-1840 | Beacon Medical Group, Inc. 4630 Vistula Rd Mishawaka IN 46544-4000 Ph: (574) 647-1900 |
| NPI Number | 1033161617 |
|---|---|
| Provider Enumeration Date | 05/16/2006 |
| Last Update Date | 02/13/2025 |
| Medicare PECOS PAC ID | 1254243306 |
|---|---|
| Medicare Enrollment ID | O20031105000657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033161617 | NPI | - | NPPES |
| 200130710A | Medicaid | IN |
| Provider Name | Brandon William Zabukovic |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710962915 PECOS PAC ID: 6204749344 Enrollment ID: I20031106000119 |
| Provider Name | Christopher D Powers |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1992702096 PECOS PAC ID: 2264345198 Enrollment ID: I20031107000119 |
| Provider Name | Matthew F Koscielski |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1629052543 PECOS PAC ID: 2567376445 Enrollment ID: I20031117000078 |
| Provider Name | Julito Yranela |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1487698213 PECOS PAC ID: 8729981360 Enrollment ID: I20040130000114 |
| Provider Name | Rosalie Lynne Mcbride |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1285661439 PECOS PAC ID: 3072416510 Enrollment ID: I20040130000785 |
| Provider Name | Kevin Small |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689669715 PECOS PAC ID: 3072406537 Enrollment ID: I20040209000938 |
| Provider Name | Howard E Wiarda |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1801881255 PECOS PAC ID: 0042104317 Enrollment ID: I20040209001222 |
| Provider Name | Luisito C Gonzales |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1164425997 PECOS PAC ID: 1759379613 Enrollment ID: I20040501000119 |
| Provider Name | Kristin J Kile |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1447241179 PECOS PAC ID: 5092703751 Enrollment ID: I20040503001160 |
| Provider Name | James W Kozelka |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1720016926 PECOS PAC ID: 5991601999 Enrollment ID: I20040511000377 |
| Provider Name | Basman Abdel Salous |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982687521 PECOS PAC ID: 9537140561 Enrollment ID: I20040526000825 |
| Provider Name | Patrick W Russell |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1144205113 PECOS PAC ID: 5395720783 Enrollment ID: I20040621000874 |
| Provider Name | Jack J Hall |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1558337857 PECOS PAC ID: 6709861743 Enrollment ID: I20040623000130 |
| Provider Name | Israr A Siddiqi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346289501 PECOS PAC ID: 6406834522 Enrollment ID: I20040713001276 |
| Provider Name | Lori Checkley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437152394 PECOS PAC ID: 6800875444 Enrollment ID: I20040716000397 |
| Provider Name | Vinod V Chauhan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831196641 PECOS PAC ID: 1052390358 Enrollment ID: I20040720000000 |
| Provider Name | Jeffrey T Szuba |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871592865 PECOS PAC ID: 2961472949 Enrollment ID: I20040728000084 |
| Provider Name | John Pete Katsaropoulos |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1063419968 PECOS PAC ID: 8729059803 Enrollment ID: I20040803000589 |
| Provider Name | Sherri Jo Biever |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982691747 PECOS PAC ID: 8022081207 Enrollment ID: I20040816001309 |
| Provider Name | John J Haskin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154351393 PECOS PAC ID: 3173597887 Enrollment ID: I20040819001133 |
| Provider Name | Shanna V Kautzmann |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134214240 PECOS PAC ID: 6406820307 Enrollment ID: I20040825001172 |
| Provider Name | Luis A Nidea |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1154311751 PECOS PAC ID: 0143295816 Enrollment ID: I20040827000223 |
| Provider Name | Robert Blaine Kolbe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639118839 PECOS PAC ID: 5193790608 Enrollment ID: I20040828000176 |
| Provider Name | Ismail Al-ani |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1578547402 PECOS PAC ID: 1557336575 Enrollment ID: I20040902000543 |
| Provider Name | Abul W Basher |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1891784500 PECOS PAC ID: 8729054341 Enrollment ID: I20040906000036 |
| Provider Name | Mark P Schmeltz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487653408 PECOS PAC ID: 9739156720 Enrollment ID: I20040910000164 |
| Provider Name | Jason E Marker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215936968 PECOS PAC ID: 7517935364 Enrollment ID: I20040920001232 |
| Provider Name | Eric J Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417958976 PECOS PAC ID: 8123096625 Enrollment ID: I20040922000760 |
| Provider Name | Kenneth E Elek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912995267 PECOS PAC ID: 7810966496 Enrollment ID: I20040930000123 |
| Provider Name | Randall J Suttor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609850908 PECOS PAC ID: 2062481641 Enrollment ID: I20040930000158 |
| Provider Name | Debra L Shemesh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528063989 PECOS PAC ID: 9537138896 Enrollment ID: I20041002000075 |
| Provider Name | Mary Helen P Havran-znavor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487650875 PECOS PAC ID: 4981673241 Enrollment ID: I20041002000079 |
| Provider Name | John F Kobayashi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1669479572 PECOS PAC ID: 9234108879 Enrollment ID: I20041002000103 |
| Provider Name | Charles A Mathis |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1326042029 PECOS PAC ID: 4981595550 Enrollment ID: I20041002000112 |
| Provider Name | Gudurutt Balakrishna Kulkarni |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1326042102 PECOS PAC ID: 2062472293 Enrollment ID: I20041013000147 |
| Provider Name | William N Farabaugh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639167901 PECOS PAC ID: 7911967492 Enrollment ID: I20041019000452 |
| Provider Name | Alberta L Henderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477541654 PECOS PAC ID: 0648231621 Enrollment ID: I20041022000633 |
| Provider Name | Thomas L Sutula |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881678183 PECOS PAC ID: 2466410295 Enrollment ID: I20041228000188 |
| Provider Name | Michael Frederick Steinberg |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1073688248 PECOS PAC ID: 1456300128 Enrollment ID: I20050120000088 |
| Provider Name | Douglas Fleming Pruitt |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1366493579 PECOS PAC ID: 2961301551 Enrollment ID: I20050131000191 |
| Provider Name | Fernando S Escovar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760481402 PECOS PAC ID: 5294786802 Enrollment ID: I20050201000523 |
| Provider Name | Cynthia Lynn Y Pascual |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962401091 PECOS PAC ID: 9739130352 Enrollment ID: I20050201000543 |
| Provider Name | Karen Christine James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811990609 PECOS PAC ID: 4981656550 Enrollment ID: I20050211000675 |
| Provider Name | Jeffrey S Howe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750380424 PECOS PAC ID: 6507818473 Enrollment ID: I20050218000603 |
| Provider Name | Laura Elizabeth Munkel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104825223 PECOS PAC ID: 1355393240 Enrollment ID: I20050218000748 |
| Provider Name | Michelle D Shelly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801863618 PECOS PAC ID: 7911950142 Enrollment ID: I20050228000450 |
| Provider Name | Joseph B Schnittker |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1629073853 PECOS PAC ID: 8022063692 Enrollment ID: I20050316000627 |
| Provider Name | Peter C Fretz |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1538148838 PECOS PAC ID: 1951358670 Enrollment ID: I20050405000935 |
| Provider Name | Stephen Smith |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1124050851 PECOS PAC ID: 2567436165 Enrollment ID: I20050502000259 |
| Provider Name | Mathew J Kallookulangara |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912998642 PECOS PAC ID: 3779555875 Enrollment ID: I20050701000337 |
| Provider Name | Narayan P Neupane |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1285675173 PECOS PAC ID: 8921044298 Enrollment ID: I20050708000175 |
| Provider Name | Sunday O Osunnuga |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710937388 PECOS PAC ID: 8820025182 Enrollment ID: I20050719000865 |
| Provider Name | Lyn M Stevens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558357749 PECOS PAC ID: 3678504990 Enrollment ID: I20050826000270 |
| Provider Name | Ashish B Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831186204 PECOS PAC ID: 0941255699 Enrollment ID: I20050913000944 |
| Provider Name | Natali M Balog |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1578552386 PECOS PAC ID: 9537192778 Enrollment ID: I20050916000898 |
| Provider Name | Zuhair Yaseen |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1093705675 PECOS PAC ID: 7416921002 Enrollment ID: I20050916000930 |
| Provider Name | David Alan Hornback |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1790770964 PECOS PAC ID: 2860419769 Enrollment ID: I20051031000306 |
| Provider Name | Russell Frederick Johnson |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1003801283 PECOS PAC ID: 7315965910 Enrollment ID: I20051102000667 |
| Provider Name | Maryann R Domingo |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1053396127 PECOS PAC ID: 9335160068 Enrollment ID: I20051209000396 |
| Provider Name | James Ou Jin |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1215900311 PECOS PAC ID: 9133133051 Enrollment ID: I20060131000341 |
| Provider Name | Kristi Michelle Troyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215959606 PECOS PAC ID: 5698781219 Enrollment ID: I20060306000456 |
| Provider Name | Stella A Ugboma |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1073574919 PECOS PAC ID: 6204735921 Enrollment ID: I20060421000344 |
| Provider Name | Michelle A Thompson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205810165 PECOS PAC ID: 3476550526 Enrollment ID: I20061102000171 |
| Provider Name | Jerome Rusceak Skelly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396729893 PECOS PAC ID: 9638176670 Enrollment ID: I20061103000315 |
| Provider Name | Jody Lynn Wiseman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215912415 PECOS PAC ID: 7416954458 Enrollment ID: I20061103000353 |
| Provider Name | Olivia G Tack |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255371514 PECOS PAC ID: 3173522786 Enrollment ID: I20061208000372 |
| Provider Name | Christopher Charles Hall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750379871 PECOS PAC ID: 9436158730 Enrollment ID: I20061214000446 |
| Provider Name | Eric S Brewer |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1700813656 PECOS PAC ID: 1254332489 Enrollment ID: I20070130000643 |
| Provider Name | Joseph M Caruso |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598763203 PECOS PAC ID: 3375648694 Enrollment ID: I20070416000376 |
| Provider Name | David C Grellmann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205824570 PECOS PAC ID: 1456456342 Enrollment ID: I20070423000110 |
| Provider Name | Hani Ahmad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790711604 PECOS PAC ID: 4385740059 Enrollment ID: I20070426000561 |
| Provider Name | Julie Chao |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1306869482 PECOS PAC ID: 9739284506 Enrollment ID: I20070509000289 |
| Provider Name | Scott M Eshowsky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285622373 PECOS PAC ID: 7719083518 Enrollment ID: I20070510000150 |
| Provider Name | Sandra A Cho |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1770522989 PECOS PAC ID: 7911004221 Enrollment ID: I20070522000285 |
| Provider Name | Michael J Hall |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1093893026 PECOS PAC ID: 6507963634 Enrollment ID: I20070523000691 |
| Provider Name | Dale Alan Patterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033115852 PECOS PAC ID: 7214036615 Enrollment ID: I20070626000568 |
| Provider Name | Vijay A Mehta |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1801921325 PECOS PAC ID: 5092814491 Enrollment ID: I20070626000604 |
| Provider Name | Elizabeth D Schalliol |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104973536 PECOS PAC ID: 9830280080 Enrollment ID: I20070802000403 |
| Provider Name | Falvy H Tunca |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1891883492 PECOS PAC ID: 3577562420 Enrollment ID: I20070906000109 |
| Provider Name | Jorge A Gonzalez |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1053365932 PECOS PAC ID: 5698687069 Enrollment ID: I20070927000505 |
| Provider Name | Jennifer A Pennington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114145687 PECOS PAC ID: 5698860898 Enrollment ID: I20071003000357 |
| Provider Name | Starla D Graber |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417956756 PECOS PAC ID: 5890881684 Enrollment ID: I20071009000718 |
| Provider Name | James Mauck |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1467480996 PECOS PAC ID: 5698701597 Enrollment ID: I20071009000768 |
| Provider Name | Tommy Mislenkov |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1912103904 PECOS PAC ID: 5991891731 Enrollment ID: I20071010000129 |
| Provider Name | Mark A Thompson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1538136361 PECOS PAC ID: 6901992965 Enrollment ID: I20071022000725 |
| Provider Name | Faiz U Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861698904 PECOS PAC ID: 1153411467 Enrollment ID: I20071226000092 |
| Provider Name | Mckindra Fletcher |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1467448019 PECOS PAC ID: 5395657605 Enrollment ID: I20080102000340 |
| Provider Name | George Larsen Kneller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598756256 PECOS PAC ID: 0244310050 Enrollment ID: I20080107000528 |
| Provider Name | Sheila Maureen Fleming |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326231689 PECOS PAC ID: 5092897835 Enrollment ID: I20080131000550 |
| Provider Name | Andrew C Mcafee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558395079 PECOS PAC ID: 6406931518 Enrollment ID: I20080313000597 |
| Provider Name | Carol D Luzzi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881764579 PECOS PAC ID: 7618053927 Enrollment ID: I20080327000278 |
| Provider Name | Abuzafar M Arif |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1447253539 PECOS PAC ID: 4284636556 Enrollment ID: I20080627000303 |
| Provider Name | Steven A Hanberg |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821180381 PECOS PAC ID: 3173695293 Enrollment ID: I20080708000034 |
| Provider Name | Juan C Vargas |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1356502033 PECOS PAC ID: 5395819023 Enrollment ID: I20080729000765 |
| Provider Name | James E Reidy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457394934 PECOS PAC ID: 8123192648 Enrollment ID: I20080801000180 |
| Provider Name | Nancy A Pudlo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467610352 PECOS PAC ID: 1456425412 Enrollment ID: I20080808000525 |
| Provider Name | James W Tieman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831173038 PECOS PAC ID: 7315014826 Enrollment ID: I20080925000408 |
| Provider Name | Tricia L Moreno |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1023172186 PECOS PAC ID: 6204994288 Enrollment ID: I20081020000477 |
| Provider Name | Reba J Goshert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912103151 PECOS PAC ID: 6709941974 Enrollment ID: I20090223000457 |
| Provider Name | Asad Ansari |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053387175 PECOS PAC ID: 0143275156 Enrollment ID: I20090305000662 |
| Provider Name | Tricia A Walters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114125739 PECOS PAC ID: 9032275482 Enrollment ID: I20090310000209 |
| Provider Name | Charlene D Howland |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1295715878 PECOS PAC ID: 5991861122 Enrollment ID: I20090312000547 |
| Provider Name | Scott C Boyd |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386639565 PECOS PAC ID: 8729145974 Enrollment ID: I20090316000588 |
| Provider Name | Daniel R Tom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558506667 PECOS PAC ID: 4082771837 Enrollment ID: I20090321000000 |
| Provider Name | Scott Alan Hanan |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1588699714 PECOS PAC ID: 8820145618 Enrollment ID: I20090414000307 |
| Provider Name | Heidi A Collins |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1093888430 PECOS PAC ID: 2062563547 Enrollment ID: I20090623000388 |
| Provider Name | Alison Fecher |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1952406910 PECOS PAC ID: 1951377829 Enrollment ID: I20090701000498 |
| Provider Name | Duane D Flaig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508080714 PECOS PAC ID: 0345394920 Enrollment ID: I20090817000294 |
| Provider Name | Tonia L Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437265337 PECOS PAC ID: 9739233115 Enrollment ID: I20090819000691 |
| Provider Name | Meredith K Wierman Schmidt |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1477762680 PECOS PAC ID: 0446347363 Enrollment ID: I20090822000019 |
| Provider Name | Maliha Iqbal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851482384 PECOS PAC ID: 3476699547 Enrollment ID: I20091002000173 |
| Provider Name | Tamara L Pinto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316270523 PECOS PAC ID: 2062550254 Enrollment ID: I20091109000372 |
| Provider Name | Sandra R Brown |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194764449 PECOS PAC ID: 9931249208 Enrollment ID: I20091217000124 |
| Provider Name | Thomas L Poulin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1497732556 PECOS PAC ID: 1153327986 Enrollment ID: I20091222000305 |
| Provider Name | Scott G Thomas |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1033196126 PECOS PAC ID: 6709865181 Enrollment ID: I20091222000338 |
| Provider Name | David W Amrhein |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952509853 PECOS PAC ID: 2062553407 Enrollment ID: I20100107000731 |
| Provider Name | Verlin T Houck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255330924 PECOS PAC ID: 0749323731 Enrollment ID: I20100129000290 |
| Provider Name | Keyna A Martinez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013941699 PECOS PAC ID: 8325182124 Enrollment ID: I20100217000463 |
| Provider Name | Danielle R Russo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346249364 PECOS PAC ID: 3779628532 Enrollment ID: I20100304000058 |
| Provider Name | Laura T Mabry |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1184952848 PECOS PAC ID: 8628113461 Enrollment ID: I20100304000901 |
| Provider Name | Terrance N Tanner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477552313 PECOS PAC ID: 6608911078 Enrollment ID: I20100310000294 |
| Provider Name | Dennis Fitzpatrick |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1831180306 PECOS PAC ID: 0143128843 Enrollment ID: I20100608000404 |
| Provider Name | Samuel D Mcgrath |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1346454998 PECOS PAC ID: 5294865705 Enrollment ID: I20100610000047 |
| Provider Name | Troy Weirick |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1679717771 PECOS PAC ID: 0840325361 Enrollment ID: I20100629000624 |
| Provider Name | Travis W Casper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215135918 PECOS PAC ID: 7214068451 Enrollment ID: I20100701000504 |
| Provider Name | Jeffrey A Steele |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1497912844 PECOS PAC ID: 2264563329 Enrollment ID: I20100706000666 |
| Provider Name | Luke A White |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1528390770 PECOS PAC ID: 3577695444 Enrollment ID: I20100713000730 |
| Provider Name | Zhaijun Fan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124225578 PECOS PAC ID: 0840322426 Enrollment ID: I20100716000647 |
| Provider Name | Daniel H Fulkerson |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1386802387 PECOS PAC ID: 4486786597 Enrollment ID: I20100724000011 |
| Provider Name | Gregory E Buck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144269861 PECOS PAC ID: 5395877443 Enrollment ID: I20100726000046 |
| Provider Name | Daniel M Kinney |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1518123124 PECOS PAC ID: 6305979204 Enrollment ID: I20100729000100 |
| Provider Name | John S Chung |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1295752731 PECOS PAC ID: 7416923834 Enrollment ID: I20100729000655 |
| Provider Name | Anish H Nayee |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1417936725 PECOS PAC ID: 7517914237 Enrollment ID: I20100730000692 |
| Provider Name | Justin J Chow |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700899622 PECOS PAC ID: 9436154275 Enrollment ID: I20100803000437 |
| Provider Name | Douglas M David |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396733101 PECOS PAC ID: 9032242656 Enrollment ID: I20100803001161 |
| Provider Name | Kirk J Bodach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306044003 PECOS PAC ID: 2062545221 Enrollment ID: I20100809000847 |
| Provider Name | Haidong Md Bao |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578723573 PECOS PAC ID: 4183758287 Enrollment ID: I20100811000415 |
| Provider Name | David Matthew Dyck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053303479 PECOS PAC ID: 6204870884 Enrollment ID: I20100820000583 |
| Provider Name | Charisse D Johnson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134399025 PECOS PAC ID: 2860516440 Enrollment ID: I20100903000042 |
| Provider Name | Walter H Halloran |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1053486191 PECOS PAC ID: 4789709924 Enrollment ID: I20100913000181 |
| Provider Name | Jerald Alan Hochstetler |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1164401469 PECOS PAC ID: 2466492772 Enrollment ID: I20100917000040 |
| Provider Name | David J. Isaacson |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1659361335 PECOS PAC ID: 1254428105 Enrollment ID: I20100920000415 |
| Provider Name | Jennifer K Carter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275847196 PECOS PAC ID: 7315139896 Enrollment ID: I20101004000566 |
| Provider Name | Muhammad Shakil Aslam |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1023053022 PECOS PAC ID: 2860594785 Enrollment ID: I20101013000749 |
| Provider Name | Shelley A Morris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376737387 PECOS PAC ID: 5799977344 Enrollment ID: I20101014000481 |
| Provider Name | Edward J Durbin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194715581 PECOS PAC ID: 4082701933 Enrollment ID: I20101026000621 |
| Provider Name | Salvatore Joseph Borrelli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114028743 PECOS PAC ID: 9335210723 Enrollment ID: I20101101001010 |
| Provider Name | Richard W Skupski |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1396722989 PECOS PAC ID: 9638364417 Enrollment ID: I20101108000453 |
| Provider Name | Jill J Newcomer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215243704 PECOS PAC ID: 9335335678 Enrollment ID: I20101129000179 |
| Provider Name | Wen S Lum |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497781124 PECOS PAC ID: 7517977788 Enrollment ID: I20110118000561 |
| Provider Name | Jennifer A Alderink |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164651758 PECOS PAC ID: 9436339207 Enrollment ID: I20110210000964 |
| Provider Name | Caitlin M Vlaeminck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083919161 PECOS PAC ID: 6709068422 Enrollment ID: I20110316000566 |
| Provider Name | Melissa C Quimby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508163999 PECOS PAC ID: 2264617588 Enrollment ID: I20110503000057 |
| Provider Name | Sally E Hull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437454808 PECOS PAC ID: 5294911640 Enrollment ID: I20110519000152 |
| Provider Name | Linda Ann Mansfield |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1629075957 PECOS PAC ID: 5496753634 Enrollment ID: I20110526000089 |
| Provider Name | Satya N Ramiah |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134378375 PECOS PAC ID: 5890973788 Enrollment ID: I20110623000507 |
| Provider Name | Leah D Craft |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467687277 PECOS PAC ID: 8921276056 Enrollment ID: I20110715000544 |
| Provider Name | Brian M Huber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538322805 PECOS PAC ID: 6901074616 Enrollment ID: I20110725000595 |
| Provider Name | Nycole Wells |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154585354 PECOS PAC ID: 6305902354 Enrollment ID: I20110929000421 |
| Provider Name | Donald Charles Mohs |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1942385174 PECOS PAC ID: 5991892655 Enrollment ID: I20111129000238 |
| Provider Name | Dennis P Erdman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710064241 PECOS PAC ID: 3476728825 Enrollment ID: I20111213000632 |
| Provider Name | Rachel Michelle Kratzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447528799 PECOS PAC ID: 3072789460 Enrollment ID: I20120106000313 |
| Provider Name | Mary Kate K Oatman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326310160 PECOS PAC ID: 6204090400 Enrollment ID: I20120620000425 |
| Provider Name | Janel L Charlton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770711145 PECOS PAC ID: 8921263401 Enrollment ID: I20120709000021 |
| Provider Name | Carlos R Bolden |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386818599 PECOS PAC ID: 8820244841 Enrollment ID: I20120807000816 |
| Provider Name | Charbel F Maskiny |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1093912180 PECOS PAC ID: 2062503998 Enrollment ID: I20120824000755 |
| Provider Name | Gina M Connolly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023364262 PECOS PAC ID: 2365691037 Enrollment ID: I20121012000774 |
| Provider Name | Jennifer Mae Potter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417209347 PECOS PAC ID: 2860642485 Enrollment ID: I20121017000234 |
| Provider Name | Justin M Grannell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609197391 PECOS PAC ID: 2668622788 Enrollment ID: I20130111000450 |
| Provider Name | Edwin L Annan |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1528245040 PECOS PAC ID: 9234205626 Enrollment ID: I20130309000055 |
| Provider Name | Susana Diaz |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1972857704 PECOS PAC ID: 7315183993 Enrollment ID: I20130426000559 |
| Provider Name | John S Gilbert |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1275735581 PECOS PAC ID: 2961534615 Enrollment ID: I20130510000191 |
| Provider Name | Kristin H Huynh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407167604 PECOS PAC ID: 2961656707 Enrollment ID: I20130730000874 |
| Provider Name | Arif Goreja |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1447215611 PECOS PAC ID: 5597666966 Enrollment ID: I20130821000658 |
| Provider Name | Lisa J Felsman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740501444 PECOS PAC ID: 2365692480 Enrollment ID: I20130829000911 |
| Provider Name | Daniel W Abel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508177619 PECOS PAC ID: 8426297896 Enrollment ID: I20130830000413 |
| Provider Name | Amrita De Patel |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1144455759 PECOS PAC ID: 6305082181 Enrollment ID: I20130920000286 |
| Provider Name | Jagadeesh V Reddy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275705691 PECOS PAC ID: 1658515259 Enrollment ID: I20130923000132 |
| Provider Name | Marjorie T Daoud |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1346276995 PECOS PAC ID: 3173578721 Enrollment ID: I20131031000663 |
| Provider Name | Gerald W Morris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508187352 PECOS PAC ID: 1355596602 Enrollment ID: I20131106001034 |
| Provider Name | Tammy G Slott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114265204 PECOS PAC ID: 7719112283 Enrollment ID: I20131109000195 |
| Provider Name | Syed Mohsan Rizvi |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1508836172 PECOS PAC ID: 4082634043 Enrollment ID: I20131118000077 |
| Provider Name | Nazmul Huda |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1609076777 PECOS PAC ID: 4981786175 Enrollment ID: I20140116000716 |
| Provider Name | Stephanie A Brenneman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932520426 PECOS PAC ID: 8921238502 Enrollment ID: I20140226002213 |
| Provider Name | Samira H El Zind |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326065285 PECOS PAC ID: 8921073248 Enrollment ID: I20140312002048 |
| Provider Name | Jose Luis Lopez |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1336352806 PECOS PAC ID: 4082883616 Enrollment ID: I20140313001889 |
| Provider Name | Brandon R Hopkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558792382 PECOS PAC ID: 2860623873 Enrollment ID: I20140314001227 |
| Provider Name | Lana L Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356770267 PECOS PAC ID: 1254562432 Enrollment ID: I20140401002248 |
| Provider Name | Monika Niemiec |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063610327 PECOS PAC ID: 3274707120 Enrollment ID: I20140403000759 |
| Provider Name | Michael N Kuria |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1154765725 PECOS PAC ID: 3971744590 Enrollment ID: I20140414001601 |
| Provider Name | Mary Alice Reid |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770574675 PECOS PAC ID: 7416189899 Enrollment ID: I20140417001447 |
| Provider Name | Jared R Dhaemers |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770533424 PECOS PAC ID: 9436382595 Enrollment ID: I20140425001880 |
| Provider Name | Jacelyn J Hostetter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831528942 PECOS PAC ID: 9638302235 Enrollment ID: I20140506001960 |
| Provider Name | Andrew G Lapadat |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841281748 PECOS PAC ID: 4789817024 Enrollment ID: I20140512001664 |
| Provider Name | Emily Rae R Singh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457490450 PECOS PAC ID: 1759474711 Enrollment ID: I20140610001044 |
| Provider Name | Marion E Mahone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891016770 PECOS PAC ID: 6002061546 Enrollment ID: I20140611000130 |
| Provider Name | Freeman L Farrow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174559900 PECOS PAC ID: 1153472121 Enrollment ID: I20140627001536 |
| Provider Name | Megan L Vermilyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033524905 PECOS PAC ID: 3072739812 Enrollment ID: I20140730002824 |
| Provider Name | Kristine E Jennings |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194011775 PECOS PAC ID: 0042464885 Enrollment ID: I20140821001153 |
| Provider Name | Matthew R Reed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821384488 PECOS PAC ID: 2860646601 Enrollment ID: I20140825000256 |
| Provider Name | Michael S Kozak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558623686 PECOS PAC ID: 3274786306 Enrollment ID: I20140916001590 |
| Provider Name | Heather A Hostetler |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1497154561 PECOS PAC ID: 1951520022 Enrollment ID: I20140923000394 |
| Provider Name | Carrie J Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104225739 PECOS PAC ID: 8527289545 Enrollment ID: I20141016000803 |
| Provider Name | Paul W Cheng |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1124052592 PECOS PAC ID: 7517991904 Enrollment ID: I20141210001617 |
| Provider Name | Janet E Kercher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598161010 PECOS PAC ID: 5294058103 Enrollment ID: I20141230000810 |
| Provider Name | Michelle Streb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861897688 PECOS PAC ID: 0143544395 Enrollment ID: I20150119000739 |
| Provider Name | Colleen B Morrison |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1437306552 PECOS PAC ID: 6901121730 Enrollment ID: I20150218002204 |
| Provider Name | Michelo Andrew Chikonka |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1083011662 PECOS PAC ID: 6002132230 Enrollment ID: I20150306001149 |
| Provider Name | Nonyem A Onujiogu |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1124262522 PECOS PAC ID: 0446300586 Enrollment ID: I20150504001106 |
| Provider Name | Jeffrey Eifler |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1003178690 PECOS PAC ID: 1759609639 Enrollment ID: I20150506002236 |
| Provider Name | Thomas Larsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285998146 PECOS PAC ID: 1355589284 Enrollment ID: I20150611000123 |
| Provider Name | Diego Heredia Vintimilla |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1831321942 PECOS PAC ID: 1557672250 Enrollment ID: I20150623000077 |
| Provider Name | Matthew T Dupre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043570369 PECOS PAC ID: 7214181056 Enrollment ID: I20150626001026 |
| Provider Name | Neal Balvant Patel |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1346475951 PECOS PAC ID: 5092953992 Enrollment ID: I20150706002374 |
| Provider Name | Stephanie N Hicks |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659647030 PECOS PAC ID: 0244463032 Enrollment ID: I20150716001585 |
| Provider Name | Kari D Sears |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548556111 PECOS PAC ID: 0446405989 Enrollment ID: I20150904002195 |
| Provider Name | Laura M Snyder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306228184 PECOS PAC ID: 8022325737 Enrollment ID: I20150914000256 |
| Provider Name | Kamran Javaid |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1306030648 PECOS PAC ID: 6901948264 Enrollment ID: I20150915001166 |
| Provider Name | Saadia Qasim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164781480 PECOS PAC ID: 7012224496 Enrollment ID: I20150917000351 |
| Provider Name | Jonathan Y Ji |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1477603504 PECOS PAC ID: 1456538172 Enrollment ID: I20150921000088 |
| Provider Name | Rachel J Pippenger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164893616 PECOS PAC ID: 0042529604 Enrollment ID: I20151021002019 |
| Provider Name | Scott D Eriksen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346611704 PECOS PAC ID: 0547560864 Enrollment ID: I20151118001123 |
| Provider Name | Teresa S Parkhouse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689042012 PECOS PAC ID: 5890095798 Enrollment ID: I20151125001398 |
| Provider Name | Catherine N Wolff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154378602 PECOS PAC ID: 4981611340 Enrollment ID: I20151203000007 |
| Provider Name | Inna V Russell |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1376786434 PECOS PAC ID: 0446396782 Enrollment ID: I20151214000388 |
| Provider Name | Staffel Oates |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1033223375 PECOS PAC ID: 4385630573 Enrollment ID: I20160217001545 |
| Provider Name | Adnan Yousuf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538424734 PECOS PAC ID: 6204069552 Enrollment ID: I20160304001089 |
| Provider Name | Margaret L Dhom |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1467817791 PECOS PAC ID: 3072819069 Enrollment ID: I20160317001334 |
| Provider Name | Rachel M Knafel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760848451 PECOS PAC ID: 1658678263 Enrollment ID: I20160328000118 |
| Provider Name | Lindsey K Troyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689031700 PECOS PAC ID: 6406153501 Enrollment ID: I20160404001368 |
| Provider Name | Rocio Ahuja |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1699057976 PECOS PAC ID: 2264603125 Enrollment ID: I20160425002539 |
| Provider Name | Amy H Deel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730547738 PECOS PAC ID: 4183913239 Enrollment ID: I20160513000415 |
| Provider Name | Emily M Kisor |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659614964 PECOS PAC ID: 2769772383 Enrollment ID: I20160609000914 |
| Provider Name | Jena R Kern |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760700454 PECOS PAC ID: 1355581307 Enrollment ID: I20160615000706 |
| Provider Name | Amanda L Springer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144660838 PECOS PAC ID: 3870726854 Enrollment ID: I20160701000683 |
| Provider Name | Usman K Qadeer |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1467728378 PECOS PAC ID: 7214229491 Enrollment ID: I20160708000296 |
| Provider Name | Caroline A Greenidge |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093761660 PECOS PAC ID: 9436151180 Enrollment ID: I20160712001822 |
| Provider Name | Nicholas H Kerr |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1033470851 PECOS PAC ID: 4587802798 Enrollment ID: I20160714002068 |
| Provider Name | Jeanna Marie Mccuddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588014914 PECOS PAC ID: 0143513390 Enrollment ID: I20160726000229 |
| Provider Name | Lindsay K Vasil |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1093169096 PECOS PAC ID: 1658664834 Enrollment ID: I20160726001056 |
| Provider Name | Kristine M Weldy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932447760 PECOS PAC ID: 2466745419 Enrollment ID: I20160728000100 |
| Provider Name | Abhishek K Das |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1932488665 PECOS PAC ID: 0840500039 Enrollment ID: I20160801002733 |
| Provider Name | Javed Malik |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1457666497 PECOS PAC ID: 8729371505 Enrollment ID: I20160802000147 |
| Provider Name | Erica Garrett |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1851748693 PECOS PAC ID: 9436449782 Enrollment ID: I20160802001666 |
| Provider Name | Heidi M Schelstraete |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912359662 PECOS PAC ID: 2668766486 Enrollment ID: I20160802001757 |
| Provider Name | Ryan Bonek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730523846 PECOS PAC ID: 9335446210 Enrollment ID: I20160805000283 |
| Provider Name | Lauren Corinne Das |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1659651735 PECOS PAC ID: 0345542254 Enrollment ID: I20160810000932 |
| Provider Name | Hanuma S Chitta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538508429 PECOS PAC ID: 0840511507 Enrollment ID: I20160822000029 |
| Provider Name | Samantha Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851743033 PECOS PAC ID: 3577858505 Enrollment ID: I20160830000301 |
| Provider Name | Tucker G Balam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861652463 PECOS PAC ID: 6204084197 Enrollment ID: I20160901000193 |
| Provider Name | Patricia L Gasper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942650726 PECOS PAC ID: 7719274653 Enrollment ID: I20160921001193 |
| Provider Name | Sara A Golden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114378635 PECOS PAC ID: 9638466196 Enrollment ID: I20160927001252 |
| Provider Name | Leslie M Peters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437502721 PECOS PAC ID: 0547558744 Enrollment ID: I20161004000078 |
| Provider Name | Gregory S Pouliot |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336549328 PECOS PAC ID: 5890083646 Enrollment ID: I20161011000133 |
| Provider Name | Gregory George Bingaman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265700090 PECOS PAC ID: 1951699404 Enrollment ID: I20161017000322 |
| Provider Name | Katie M Schramm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033668561 PECOS PAC ID: 5395025092 Enrollment ID: I20161215002209 |
| Provider Name | Sharlotte Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619428141 PECOS PAC ID: 1052692985 Enrollment ID: I20170106001521 |
| Provider Name | Amjad Q Syed |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1932367083 PECOS PAC ID: 4385885938 Enrollment ID: I20170110002883 |
| Provider Name | Jason A Mancini |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1528502572 PECOS PAC ID: 0244512952 Enrollment ID: I20170112001836 |
| Provider Name | Kathryn A Kenney |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518256098 PECOS PAC ID: 5597903062 Enrollment ID: I20170511002237 |
| Provider Name | Shelby L Towner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073048260 PECOS PAC ID: 5991072001 Enrollment ID: I20170522000080 |
| Provider Name | Joshua Lotfallah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114272184 PECOS PAC ID: 4284865932 Enrollment ID: I20170607001394 |
| Provider Name | John A Whitney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205240637 PECOS PAC ID: 7719102466 Enrollment ID: I20170629002691 |
| Provider Name | Benjamin Olugbenga Adebayo |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437415460 PECOS PAC ID: 1052615184 Enrollment ID: I20170705001492 |
| Provider Name | Shana'e C Sobieray |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1598285686 PECOS PAC ID: 1254600257 Enrollment ID: I20170707000465 |
| Provider Name | Chiedu Charles Onunkwo |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1992752018 PECOS PAC ID: 8325066988 Enrollment ID: I20170721000181 |
| Provider Name | Kashif Shaikh |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1417243189 PECOS PAC ID: 1658679931 Enrollment ID: I20170731001323 |
| Provider Name | Mayank K Mittal |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1003044702 PECOS PAC ID: 1153643390 Enrollment ID: I20170807000380 |
| Provider Name | Diane R Sharkey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023549052 PECOS PAC ID: 9234401886 Enrollment ID: I20170817000734 |
| Provider Name | Chad W Katona |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1760703334 PECOS PAC ID: 5395982961 Enrollment ID: I20170823002471 |
| Provider Name | Tyne Marie Simpson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184142721 PECOS PAC ID: 6103190558 Enrollment ID: I20170922002574 |
| Provider Name | Bethanie Wrobleski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700303070 PECOS PAC ID: 2062788128 Enrollment ID: I20171018000950 |
| Provider Name | Traci R Pulliam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023533890 PECOS PAC ID: 9739445081 Enrollment ID: I20171102001785 |
| Provider Name | Laura C Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851818132 PECOS PAC ID: 7214293760 Enrollment ID: I20171116000144 |
| Provider Name | Jennifer Jean Loop-miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730698267 PECOS PAC ID: 0840557450 Enrollment ID: I20171206000823 |
| Provider Name | Alison S Haffner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952814113 PECOS PAC ID: 2961761077 Enrollment ID: I20180118000989 |
| Provider Name | Joel Marcus Post |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1407014442 PECOS PAC ID: 1951535806 Enrollment ID: I20180208001564 |
| Provider Name | Amber Michelle Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679716534 PECOS PAC ID: 9436419538 Enrollment ID: I20180212000149 |
| Provider Name | Anne Beth Schaap |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477735629 PECOS PAC ID: 0042570152 Enrollment ID: I20180212000314 |
| Provider Name | Sarah Ann Filchak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689992984 PECOS PAC ID: 1850651712 Enrollment ID: I20180214001390 |
| Provider Name | Jamie Hembrecht |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770981201 PECOS PAC ID: 5395003214 Enrollment ID: I20180306002176 |
| Provider Name | Laura Anne Deak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881861573 PECOS PAC ID: 7113288143 Enrollment ID: I20180307002035 |
| Provider Name | Ann Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104167386 PECOS PAC ID: 5092076935 Enrollment ID: I20180309001349 |
| Provider Name | Ricky J Deville |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1457692857 PECOS PAC ID: 7719121284 Enrollment ID: I20180315000990 |
| Provider Name | Tracy Lynne Mcneill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528431632 PECOS PAC ID: 8921361064 Enrollment ID: I20180424001214 |
| Provider Name | Michelle Dawn Orona |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780192922 PECOS PAC ID: 3072876119 Enrollment ID: I20180424001407 |
| Provider Name | Samantha Lynn Jester |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1275041865 PECOS PAC ID: 0749540565 Enrollment ID: I20180427000393 |
| Provider Name | Gregg M Ebersole |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1093000366 PECOS PAC ID: 7416259940 Enrollment ID: I20180501000540 |
| Provider Name | Scott David Hurley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326380247 PECOS PAC ID: 4981837689 Enrollment ID: I20180523000520 |
| Provider Name | Brook Elizabeth Arney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811244304 PECOS PAC ID: 8628323896 Enrollment ID: I20180613000391 |
| Provider Name | David T Gursky |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1821331703 PECOS PAC ID: 1951656008 Enrollment ID: I20180614000424 |
| Provider Name | Emilee M Tehrani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073042024 PECOS PAC ID: 2466707047 Enrollment ID: I20180622000969 |
| Provider Name | Austin W Pulliam |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1518301118 PECOS PAC ID: 3375761190 Enrollment ID: I20180628002438 |
| Provider Name | Quanri Jin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992148811 PECOS PAC ID: 7517260938 Enrollment ID: I20180703000421 |
| Provider Name | Jonathan H Abiera |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1689055451 PECOS PAC ID: 5496067100 Enrollment ID: I20180710000716 |
| Provider Name | Christopher Frederick Ketcham |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1780098780 PECOS PAC ID: 0941512362 Enrollment ID: I20180710001002 |
| Provider Name | Rachel Elizabeth Schuster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437532223 PECOS PAC ID: 7113236787 Enrollment ID: I20180717000617 |
| Provider Name | Julie Ann Coyle |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619381993 PECOS PAC ID: 6901022250 Enrollment ID: I20180718000537 |
| Provider Name | Jonathan Vida |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487041042 PECOS PAC ID: 2466768635 Enrollment ID: I20180718000787 |
| Provider Name | Jason Stegink |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285011957 PECOS PAC ID: 8123331345 Enrollment ID: I20180718000831 |
| Provider Name | Myron Glen Bontrager |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801283528 PECOS PAC ID: 2466721642 Enrollment ID: I20180725000065 |
| Provider Name | Kevin Francis Cumper |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1285072454 PECOS PAC ID: 8224322318 Enrollment ID: I20180725001339 |
| Provider Name | Alana John |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1760730824 PECOS PAC ID: 2769730084 Enrollment ID: I20180802002606 |
| Provider Name | Jared Andrew Vogler |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1164560108 PECOS PAC ID: 1456650431 Enrollment ID: I20180808000540 |
| Provider Name | Emily Milliken |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629565130 PECOS PAC ID: 7315295326 Enrollment ID: I20180808001259 |
| Provider Name | Matthew Scott Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952794570 PECOS PAC ID: 5991054967 Enrollment ID: I20180823003656 |
| Provider Name | Hillary L Davis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073961918 PECOS PAC ID: 1456642628 Enrollment ID: I20180824000951 |
| Provider Name | Erin H Hendricks |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386063345 PECOS PAC ID: 9830312255 Enrollment ID: I20180918000574 |
| Provider Name | David Velasco |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1609360965 PECOS PAC ID: 4082965231 Enrollment ID: I20180926003849 |
| Provider Name | Kristin Marie Wymer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679058762 PECOS PAC ID: 9830442029 Enrollment ID: I20181106001232 |
| Provider Name | Aisha Siddiqui |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1972713386 PECOS PAC ID: 8729153721 Enrollment ID: I20181119000592 |
| Provider Name | Cody Seamons |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1437627247 PECOS PAC ID: 1951646298 Enrollment ID: I20181214001412 |
| Provider Name | Stacey Rene Le Fevre Young |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538470018 PECOS PAC ID: 6305181322 Enrollment ID: I20181219003632 |
| Provider Name | Erin E Barth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265951578 PECOS PAC ID: 2769727239 Enrollment ID: I20190103000479 |
| Provider Name | Melissa E. Holderread |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1477977767 PECOS PAC ID: 2668604943 Enrollment ID: I20190114002321 |
| Provider Name | Lora D Defreese |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1336618644 PECOS PAC ID: 4880931021 Enrollment ID: I20190128000138 |
| Provider Name | John Walsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316427560 PECOS PAC ID: 2062759764 Enrollment ID: I20190201001873 |
| Provider Name | Melissa Ann Demetriou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225551591 PECOS PAC ID: 4082952320 Enrollment ID: I20190213000435 |
| Provider Name | Jessica S Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851865174 PECOS PAC ID: 3476893066 Enrollment ID: I20190318002121 |
| Provider Name | Daniela M Edson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447721105 PECOS PAC ID: 9739420001 Enrollment ID: I20190415001456 |
| Provider Name | Justin J Koenig |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1821314360 PECOS PAC ID: 2860702404 Enrollment ID: I20190416002179 |
| Provider Name | Muhammad Uzair Saqlain |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1730494915 PECOS PAC ID: 9638311673 Enrollment ID: I20190508003460 |
| Provider Name | Leeann Marie Enix |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306360227 PECOS PAC ID: 3870866296 Enrollment ID: I20190610000396 |
| Provider Name | Stacy L Snyder |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477896348 PECOS PAC ID: 5294068128 Enrollment ID: I20190610000587 |
| Provider Name | Elvie J Frey |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1457916140 PECOS PAC ID: 1456684950 Enrollment ID: I20190617001363 |
| Provider Name | Muhammad Omer Toor |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1477868180 PECOS PAC ID: 1456592419 Enrollment ID: I20190620000573 |
| Provider Name | Anthony Vida |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710398359 PECOS PAC ID: 2365719515 Enrollment ID: I20190708000748 |
| Provider Name | Ryan D Enck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518316637 PECOS PAC ID: 7214229186 Enrollment ID: I20190710000420 |
| Provider Name | Katherine D Goze |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1326459108 PECOS PAC ID: 6002031002 Enrollment ID: I20190718000248 |
| Provider Name | Sherri Ann Hayes |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1730187733 PECOS PAC ID: 3870497191 Enrollment ID: I20190814001821 |
| Provider Name | Philip D Dibert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609436864 PECOS PAC ID: 0345579983 Enrollment ID: I20190909000455 |
| Provider Name | Rachael Rae Schulte |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1205192408 PECOS PAC ID: 5092044065 Enrollment ID: I20190917002264 |
| Provider Name | Chasity Stahl |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1306401914 PECOS PAC ID: 6507197522 Enrollment ID: I20191007000059 |
| Provider Name | Pierre Andre Ovide |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1215179643 PECOS PAC ID: 5597197665 Enrollment ID: I20191111001261 |
| Provider Name | Sneha Rao |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1255637450 PECOS PAC ID: 7214180652 Enrollment ID: I20191211000291 |
| Provider Name | Sunny Marie Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114564762 PECOS PAC ID: 6709210917 Enrollment ID: I20191221000342 |
| Provider Name | Jennifer Clare Prins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821386707 PECOS PAC ID: 4183932841 Enrollment ID: I20191226001896 |
| Provider Name | Latoya Jeaneen Perry |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1629255880 PECOS PAC ID: 6103042114 Enrollment ID: I20200115000423 |
| Provider Name | Joshua C Stewart |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1083258099 PECOS PAC ID: 6608201694 Enrollment ID: I20200122000772 |
| Provider Name | Yolanda Kelbel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073159174 PECOS PAC ID: 8325473101 Enrollment ID: I20200124001680 |
| Provider Name | Adam E Collier |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1891333522 PECOS PAC ID: 8921434812 Enrollment ID: I20200213000816 |
| Provider Name | Adam Wilson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1033167028 PECOS PAC ID: 0648418541 Enrollment ID: I20200218000723 |
| Provider Name | Kyra Tatman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679768774 PECOS PAC ID: 2567522576 Enrollment ID: I20200305001237 |
| Provider Name | Kristen A Atwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316587165 PECOS PAC ID: 6103254362 Enrollment ID: I20200322000065 |
| Provider Name | Sarah E Geyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528698081 PECOS PAC ID: 3072941194 Enrollment ID: I20200323002952 |
| Provider Name | Melanie Lillian Leveille |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1215322052 PECOS PAC ID: 9537465943 Enrollment ID: I20200323003432 |
| Provider Name | Betsy Rossow |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841247095 PECOS PAC ID: 4183052236 Enrollment ID: I20200324000672 |
| Provider Name | Lindsay Jo Kramer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770808081 PECOS PAC ID: 9638507718 Enrollment ID: I20200324001969 |
| Provider Name | Karissa M Misner |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1063566818 PECOS PAC ID: 4789743253 Enrollment ID: I20200408000290 |
| Provider Name | Sarah O'connor |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1720474620 PECOS PAC ID: 8820428436 Enrollment ID: I20200422003305 |
| Provider Name | Bradley Balint |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366820359 PECOS PAC ID: 9133559420 Enrollment ID: I20200429001700 |
| Provider Name | Amanda Kathrine Willems Dutkiewicz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891989539 PECOS PAC ID: 2466532494 Enrollment ID: I20200429001769 |
| Provider Name | Hari Rasad Gourabathini |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184012130 PECOS PAC ID: 6901236298 Enrollment ID: I20200429001983 |
| Provider Name | Deepak N. Gaba |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1366404782 PECOS PAC ID: 2163557281 Enrollment ID: I20200605000757 |
| Provider Name | Daniel J Weber |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1942520762 PECOS PAC ID: 6507082815 Enrollment ID: I20200608000954 |
| Provider Name | Muhammad A Saeed |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1073922522 PECOS PAC ID: 8426322694 Enrollment ID: I20200612000465 |
| Provider Name | Katharine A Callaghan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902330046 PECOS PAC ID: 4385912989 Enrollment ID: I20200624002202 |
| Provider Name | Sara Irene Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710516059 PECOS PAC ID: 0941623771 Enrollment ID: I20200713000180 |
| Provider Name | Lauren Jean White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306117882 PECOS PAC ID: 8022233626 Enrollment ID: I20200721001608 |
| Provider Name | Johnny Lee Gerardot |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336673037 PECOS PAC ID: 5991073496 Enrollment ID: I20200728001958 |
| Provider Name | Jazmine Weldy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912527474 PECOS PAC ID: 4183049737 Enrollment ID: I20200730001136 |
| Provider Name | Julie Beth Motycka |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1821009259 PECOS PAC ID: 4688861073 Enrollment ID: I20200814000496 |
| Provider Name | Heather L Saffel |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1700231313 PECOS PAC ID: 4486948452 Enrollment ID: I20200814000962 |
| Provider Name | Patricia Caroline Osmolak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194102723 PECOS PAC ID: 5597067256 Enrollment ID: I20200817000984 |
| Provider Name | Jamie O'rear |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1871987735 PECOS PAC ID: 1557667151 Enrollment ID: I20200824000429 |
| Provider Name | Lindsay Jo Blazin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1275875643 PECOS PAC ID: 9436576980 Enrollment ID: I20200828000400 |
| Provider Name | Katelyn J. Yoder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801412085 PECOS PAC ID: 4082032990 Enrollment ID: I20200909001801 |
| Provider Name | Glen E Oriaifo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104271618 PECOS PAC ID: 4385938604 Enrollment ID: I20201009000770 |
| Provider Name | Kevin Taubman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1811101132 PECOS PAC ID: 1658463310 Enrollment ID: I20201023002116 |
| Provider Name | Tara Christine Jones |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1396381562 PECOS PAC ID: 0244640191 Enrollment ID: I20201103002744 |
| Provider Name | Navid Etemadi |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1417303074 PECOS PAC ID: 1951694454 Enrollment ID: I20201106001928 |
| Provider Name | Michael Alan Boyd |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1407955248 PECOS PAC ID: 8921187410 Enrollment ID: I20201116002350 |
| Provider Name | Abhay Kumar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1093942708 PECOS PAC ID: 9335263565 Enrollment ID: I20201201001157 |
| Provider Name | Marlise Ann Webber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295336642 PECOS PAC ID: 0648681197 Enrollment ID: I20201204001399 |
| Provider Name | Julia Chairez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902430580 PECOS PAC ID: 0345652723 Enrollment ID: I20201208001946 |
| Provider Name | Asma Iftikhar |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1427344761 PECOS PAC ID: 2163664715 Enrollment ID: I20201208002955 |
| Provider Name | Sedra Jo Ketcham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578803045 PECOS PAC ID: 6002054756 Enrollment ID: I20201215000476 |
| Provider Name | Gabriel Lewis |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1093316176 PECOS PAC ID: 9830502491 Enrollment ID: I20201229001079 |
| Provider Name | Sheryl Ann Vinci |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710403282 PECOS PAC ID: 6507196359 Enrollment ID: I20210218001457 |
| Provider Name | Ashley Amanda Saia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407444367 PECOS PAC ID: 8426464272 Enrollment ID: I20210303001074 |
| Provider Name | Nicole E Rose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922697572 PECOS PAC ID: 3072929355 Enrollment ID: I20210311000680 |
| Provider Name | Andrew Rosner Berkson |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1255304010 PECOS PAC ID: 1850326893 Enrollment ID: I20210311002709 |
| Provider Name | Nadia N Bowling |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1992167746 PECOS PAC ID: 9739510736 Enrollment ID: I20210419001376 |
| Provider Name | Janus Allen Flora |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679162614 PECOS PAC ID: 1557779105 Enrollment ID: I20210420000925 |
| Provider Name | Travis Lee Healey |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1639527401 PECOS PAC ID: 3577857481 Enrollment ID: I20210427002404 |
| Provider Name | Catherine A Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730702499 PECOS PAC ID: 9436568375 Enrollment ID: I20210506000717 |
| Provider Name | Dyllan Tiburzi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326536095 PECOS PAC ID: 0143584391 Enrollment ID: I20210524001610 |
| Provider Name | Adil Wani |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1114335866 PECOS PAC ID: 7315167509 Enrollment ID: I20210525002926 |
| Provider Name | Ryan Matthew Lingle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891290631 PECOS PAC ID: 9537416904 Enrollment ID: I20210527001425 |
| Provider Name | Wei Xia Huff |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1245644574 PECOS PAC ID: 1759506892 Enrollment ID: I20210617001417 |
| Provider Name | Rebecca J Mahlie |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1932783958 PECOS PAC ID: 8820499924 Enrollment ID: I20210628000635 |
| Provider Name | Andrea Gentile |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1942664784 PECOS PAC ID: 6406145077 Enrollment ID: I20210716002455 |
| Provider Name | Brendan T Durr |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1205220456 PECOS PAC ID: 4688978976 Enrollment ID: I20210721000606 |
| Provider Name | Kiesha Nicole Anderson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1720439680 PECOS PAC ID: 9133412422 Enrollment ID: I20210802001164 |
| Provider Name | Kenneth Francis Raderstorf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023682416 PECOS PAC ID: 8022412790 Enrollment ID: I20210803003525 |
| Provider Name | Dylan Garvey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679157929 PECOS PAC ID: 3476957143 Enrollment ID: I20210803003605 |
| Provider Name | Sara Lynn Utz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497328504 PECOS PAC ID: 2668876848 Enrollment ID: I20210810002792 |
| Provider Name | Robert Alan Fiedler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962074583 PECOS PAC ID: 4385048560 Enrollment ID: I20210810002850 |
| Provider Name | Yena Choi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619438868 PECOS PAC ID: 2062747264 Enrollment ID: I20210810002919 |
| Provider Name | Leeanne F Torres |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1427444165 PECOS PAC ID: 3779904867 Enrollment ID: I20210816000160 |
| Provider Name | Amber Lee Lichtenbarger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821587874 PECOS PAC ID: 2466717723 Enrollment ID: I20210816000638 |
| Provider Name | Marissa A Just |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912325028 PECOS PAC ID: 0648674531 Enrollment ID: I20210816000733 |
| Provider Name | Mitchell Everett Daugherty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417481540 PECOS PAC ID: 9638447238 Enrollment ID: I20210819003594 |
| Provider Name | Eric Sadek Mccoy |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1942572797 PECOS PAC ID: 6800297664 Enrollment ID: I20210824000974 |
| Provider Name | Mary Elizabeth Campbell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942799838 PECOS PAC ID: 1658777693 Enrollment ID: I20210831001159 |
| Provider Name | Eric Charles Smuclovisky |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1700265634 PECOS PAC ID: 6901202340 Enrollment ID: I20210909001888 |
| Provider Name | Khalid Najib |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1558626077 PECOS PAC ID: 4981918265 Enrollment ID: I20210910002730 |
| Provider Name | Zachary Wylie Laucis |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1497168314 PECOS PAC ID: 6608135587 Enrollment ID: I20210922002372 |
| Provider Name | Rebecca M Tarwacki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790355634 PECOS PAC ID: 2860880713 Enrollment ID: I20211026000340 |
| Provider Name | Aroba Sadaf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689193211 PECOS PAC ID: 7618398777 Enrollment ID: I20211027001526 |
| Provider Name | Jacqueline R Albiez-dobransky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447928007 PECOS PAC ID: 1557759305 Enrollment ID: I20211027001528 |
| Provider Name | Kathryn Bachman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124430459 PECOS PAC ID: 1052532678 Enrollment ID: I20211108001705 |
| Provider Name | Matthew A Nash |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1740257930 PECOS PAC ID: 0143260588 Enrollment ID: I20211115002493 |
| Provider Name | Sushma Manda |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558524603 PECOS PAC ID: 7113051392 Enrollment ID: I20211222000164 |
| Provider Name | Paul Misch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942277876 PECOS PAC ID: 5799749396 Enrollment ID: I20220224001452 |
| Provider Name | George P Tavoulareas |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1427058858 PECOS PAC ID: 3072619972 Enrollment ID: I20220225001936 |
| Provider Name | Ameer Alwafai |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1255644779 PECOS PAC ID: 6901190362 Enrollment ID: I20220415000590 |
| Provider Name | Siarhei Slinko |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356507636 PECOS PAC ID: 6507014644 Enrollment ID: I20220425000794 |
| Provider Name | Frank J Zbierajewski |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1033449657 PECOS PAC ID: 4688716772 Enrollment ID: I20220426002882 |
| Provider Name | Hannah Grace Yoder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083360812 PECOS PAC ID: 5193112662 Enrollment ID: I20220502001269 |
| Provider Name | Daphne Pontius |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700403581 PECOS PAC ID: 2365829132 Enrollment ID: I20220517000610 |
| Provider Name | Chad Miller |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1467477901 PECOS PAC ID: 4183522212 Enrollment ID: I20220518002933 |
| Provider Name | Edward Olson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1427225184 PECOS PAC ID: 1052473410 Enrollment ID: I20220519001953 |
| Provider Name | Raveesh Daniel Richard |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1376836437 PECOS PAC ID: 3870897382 Enrollment ID: I20220615002158 |
| Provider Name | Venu Vadlamudi |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1952508699 PECOS PAC ID: 2062656903 Enrollment ID: I20220720001202 |
| Provider Name | Ethan Richard Wren |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1124487301 PECOS PAC ID: 1951782754 Enrollment ID: I20220725001580 |
| Provider Name | William A Castaldo |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1588669139 PECOS PAC ID: 1153233317 Enrollment ID: I20220729001161 |
| Provider Name | Amber J Taylor |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1023618063 PECOS PAC ID: 0840605333 Enrollment ID: I20220729001239 |
| Provider Name | Brian E Schirf |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1184840290 PECOS PAC ID: 6901979780 Enrollment ID: I20220730000210 |
| Provider Name | Sonia Nga-shun Yuen |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1487187894 PECOS PAC ID: 5890065122 Enrollment ID: I20220809002596 |
| Provider Name | Daniel Srikureja |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1235455270 PECOS PAC ID: 5092027730 Enrollment ID: I20220813000087 |
| Provider Name | Chinyama Munakampe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770146185 PECOS PAC ID: 0840524492 Enrollment ID: I20220816001606 |
| Provider Name | William Anderson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1194177451 PECOS PAC ID: 8224321393 Enrollment ID: I20220825002102 |
| Provider Name | Shawn Marie Seward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528795325 PECOS PAC ID: 0547644247 Enrollment ID: I20220830001388 |
| Provider Name | Ryan J O'rourke |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1801244827 PECOS PAC ID: 5890088272 Enrollment ID: I20220831000157 |
| Provider Name | Haley Anne Bywaters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801540034 PECOS PAC ID: 2961886346 Enrollment ID: I20220902001601 |
| Provider Name | Pratik Patel |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1447641303 PECOS PAC ID: 1951693316 Enrollment ID: I20220908002977 |
| Provider Name | Nicholas Raymond Pechin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760987275 PECOS PAC ID: 2466708516 Enrollment ID: I20220921000415 |
| Provider Name | Kellen J Mastick |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1538655709 PECOS PAC ID: 9739564014 Enrollment ID: I20220922002812 |
| Provider Name | Alyssa Ciera Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598394736 PECOS PAC ID: 2567883309 Enrollment ID: I20220929000628 |
| Provider Name | Jason A Green |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1528075975 PECOS PAC ID: 7911993183 Enrollment ID: I20221008000151 |
| Provider Name | Amanda Marie Huff |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1316517782 PECOS PAC ID: 2163828997 Enrollment ID: I20221011001934 |
| Provider Name | Tracie Dyann Belcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053042762 PECOS PAC ID: 4880060409 Enrollment ID: I20221021001036 |
| Provider Name | Theresa L Malcom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871224576 PECOS PAC ID: 6406222991 Enrollment ID: I20221025002513 |
| Provider Name | Madison Ashley Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407580533 PECOS PAC ID: 3274909627 Enrollment ID: I20221026001680 |
| Provider Name | Andrew C Wirebaugh |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1043358898 PECOS PAC ID: 3072673144 Enrollment ID: I20221027000175 |
| Provider Name | Shelby E Patterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710611603 PECOS PAC ID: 1557738663 Enrollment ID: I20221102002229 |
| Provider Name | Jennifer M Swain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992437602 PECOS PAC ID: 0941677843 Enrollment ID: I20221107000872 |
| Provider Name | Gaurav Thakur |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1184078248 PECOS PAC ID: 8426328667 Enrollment ID: I20221108002737 |
| Provider Name | Megan E Conway |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1063895845 PECOS PAC ID: 2961708250 Enrollment ID: I20221109000296 |
| Provider Name | Stephanie Marie Fischer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215665716 PECOS PAC ID: 1153798889 Enrollment ID: I20221109000352 |
| Provider Name | Kelsey Renae Namisnak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275267171 PECOS PAC ID: 4486021011 Enrollment ID: I20221110001124 |
| Provider Name | David Po-jen Chi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1932662780 PECOS PAC ID: 3375886856 Enrollment ID: I20221115000327 |
| Provider Name | Nicole Ashley Wheeler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346975356 PECOS PAC ID: 1456729862 Enrollment ID: I20221116000436 |
| Provider Name | Tamara Ann Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891420154 PECOS PAC ID: 8921476086 Enrollment ID: I20221121001657 |
| Provider Name | Alyssa Lynne Ingle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841927449 PECOS PAC ID: 5698143600 Enrollment ID: I20221123000828 |
| Provider Name | Amanda Rose Doeden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841912292 PECOS PAC ID: 4385012293 Enrollment ID: I20221128001660 |
| Provider Name | Michelle L Wright |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1154057818 PECOS PAC ID: 6709255359 Enrollment ID: I20221205000267 |
| Provider Name | Maria T Rapciak |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1952675365 PECOS PAC ID: 0042505356 Enrollment ID: I20221216002014 |
| Provider Name | Adam E Gabrielsen |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1235758590 PECOS PAC ID: 4082039888 Enrollment ID: I20221223001291 |
| Provider Name | Alyssa M Erskine |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902396757 PECOS PAC ID: 6709141385 Enrollment ID: I20221230000395 |
| Provider Name | Joseph Schneider |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1003914292 PECOS PAC ID: 4486699121 Enrollment ID: I20230114000123 |
| Provider Name | Stephen Cates |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679076012 PECOS PAC ID: 0143639328 Enrollment ID: I20230120001427 |
| Provider Name | Angel L Roberson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497477608 PECOS PAC ID: 9739550096 Enrollment ID: I20230124001449 |
| Provider Name | Sara J Mahoney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881312932 PECOS PAC ID: 1456722719 Enrollment ID: I20230124001481 |
| Provider Name | Benjamin J. Pell |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1346637022 PECOS PAC ID: 0244544641 Enrollment ID: I20230202000295 |
| Provider Name | Devin R Kinney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497462576 PECOS PAC ID: 5092187765 Enrollment ID: I20230206001527 |
| Provider Name | Paul N Zenker |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659452811 PECOS PAC ID: 0143457234 Enrollment ID: I20230207000904 |
| Provider Name | Michael Ginsburg |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1417189549 PECOS PAC ID: 3779899158 Enrollment ID: I20230310001454 |
| Provider Name | Haley E Boyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821706763 PECOS PAC ID: 7618341769 Enrollment ID: I20230313002569 |
| Provider Name | Andrea Rebecca Edmister |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1265766703 PECOS PAC ID: 1951622133 Enrollment ID: I20230327001374 |
| Provider Name | Olanrewaju O Agbe-davies |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1639431059 PECOS PAC ID: 6204148653 Enrollment ID: I20230403000978 |
| Provider Name | Varoon Thavapalan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1568740546 PECOS PAC ID: 6709000417 Enrollment ID: I20230417000514 |
| Provider Name | Walter Raul Osorio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811608334 PECOS PAC ID: 4587020474 Enrollment ID: I20230518002795 |
| Provider Name | Harrison Glen Walter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871176263 PECOS PAC ID: 5698176212 Enrollment ID: I20230518003358 |
| Provider Name | Erik Thordarson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497251045 PECOS PAC ID: 3870824154 Enrollment ID: I20230628000690 |
| Provider Name | Marble Simbi-mujeye |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1932877693 PECOS PAC ID: 6709246598 Enrollment ID: I20230712000192 |
| Provider Name | Cody Lane Ward |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316501257 PECOS PAC ID: 6103150594 Enrollment ID: I20230712004530 |
| Provider Name | Benjamin Daniel Hughes |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1710504246 PECOS PAC ID: 1850751488 Enrollment ID: I20230714000821 |
| Provider Name | Nicholas Miller |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164926515 PECOS PAC ID: 5193185544 Enrollment ID: I20230717001713 |
| Provider Name | Erich K Deason |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1801149190 PECOS PAC ID: 5597916718 Enrollment ID: I20230720000293 |
| Provider Name | Lila E Sheikhi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1457790032 PECOS PAC ID: 8527484278 Enrollment ID: I20230721003131 |
| Provider Name | Sidrah Najam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982268959 PECOS PAC ID: 7113251406 Enrollment ID: I20230731001090 |
| Provider Name | Jaclyn Ann Fusco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063113355 PECOS PAC ID: 3375904840 Enrollment ID: I20230731002737 |
| Provider Name | James Alan Handtke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033748710 PECOS PAC ID: 3072935386 Enrollment ID: I20230731002912 |
| Provider Name | Francesca Ursua |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215553607 PECOS PAC ID: 7517385719 Enrollment ID: I20230801000944 |
| Provider Name | Marcy Lee Floyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215623301 PECOS PAC ID: 7618338849 Enrollment ID: I20230803001583 |
| Provider Name | Adam Snoap |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1013440890 PECOS PAC ID: 9537432034 Enrollment ID: I20230811000525 |
| Provider Name | Anthony Simon |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1245938505 PECOS PAC ID: 6608238225 Enrollment ID: I20230815000728 |
| Provider Name | Will Cowan |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1750908844 PECOS PAC ID: 3779945092 Enrollment ID: I20230817001678 |
| Provider Name | Deborah Michelle Pavey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417577271 PECOS PAC ID: 0547622813 Enrollment ID: I20230817003728 |
| Provider Name | Garrett Muhlstadt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609496686 PECOS PAC ID: 7517389877 Enrollment ID: I20230905001549 |
| Provider Name | Erin J Brady |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1730457797 PECOS PAC ID: 6901056944 Enrollment ID: I20230905003974 |
| Provider Name | Colin T Fath |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1811300817 PECOS PAC ID: 0345466009 Enrollment ID: I20230911003377 |
| Provider Name | Celestina I Iheanacho |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619927530 PECOS PAC ID: 7911915558 Enrollment ID: I20230913003982 |
| Provider Name | Shumaila Muhammad Iqbal |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1841712999 PECOS PAC ID: 9739427428 Enrollment ID: I20230914002374 |
| Provider Name | Niraj A Arora |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225399488 PECOS PAC ID: 9537417373 Enrollment ID: I20230922001025 |
| Provider Name | Walter Morgan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225290497 PECOS PAC ID: 8729221247 Enrollment ID: I20230925001799 |
| Provider Name | Benjamin Tate Fedeles |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1932561792 PECOS PAC ID: 3375838121 Enrollment ID: I20230926002307 |
| Provider Name | Shirley Chen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013105121 PECOS PAC ID: 1850434853 Enrollment ID: I20230928001993 |
| Provider Name | Sabrena M Ahmadi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013465103 PECOS PAC ID: 9931450244 Enrollment ID: I20231002002058 |
| Provider Name | Hafiz Aslam |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1740761915 PECOS PAC ID: 5092137380 Enrollment ID: I20231004001989 |
| Provider Name | Erik Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831867555 PECOS PAC ID: 1153776372 Enrollment ID: I20231009001100 |
| Provider Name | James F Bartscher |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1033239041 PECOS PAC ID: 8921296906 Enrollment ID: I20231031002762 |
| Provider Name | Ashlee N Trensey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326731787 PECOS PAC ID: 8527415157 Enrollment ID: I20231103001187 |
| Provider Name | Osmond Chia-liang Wu |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1972861201 PECOS PAC ID: 1850627308 Enrollment ID: I20231103001544 |
| Provider Name | Jacob Floyd Keultjes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336830454 PECOS PAC ID: 4082061437 Enrollment ID: I20231107003416 |
| Provider Name | Jamie L Thacker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548998131 PECOS PAC ID: 0244687606 Enrollment ID: I20231107003523 |
| Provider Name | Travis Doyle Weaver |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063808772 PECOS PAC ID: 5294084521 Enrollment ID: I20231122002198 |
| Provider Name | Kathryn Demitruk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386138998 PECOS PAC ID: 4385991249 Enrollment ID: I20231127001637 |
| Provider Name | Basharat N Buchh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609802107 PECOS PAC ID: 8527243179 Enrollment ID: I20231208000903 |
| Provider Name | Meghan R Hamlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467230854 PECOS PAC ID: 4981053485 Enrollment ID: I20231208002910 |
| Provider Name | Jamie Lynn Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194505206 PECOS PAC ID: 9436509080 Enrollment ID: I20231222002192 |
| Provider Name | Henry Kirori |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225816739 PECOS PAC ID: 3971953480 Enrollment ID: I20231226001284 |
| Provider Name | Robert S Crumb |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1376516732 PECOS PAC ID: 1153347844 Enrollment ID: I20240206003454 |
| Provider Name | Kristyn M Beaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861150955 PECOS PAC ID: 5092100677 Enrollment ID: I20240220002769 |
| Provider Name | Linda M Weisberg |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1871123687 PECOS PAC ID: 3779913066 Enrollment ID: I20240313000804 |
| Provider Name | Andrea N Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518678747 PECOS PAC ID: 2860839404 Enrollment ID: I20240319001927 |
| Provider Name | Nicole M Gauthier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790546653 PECOS PAC ID: 6709223340 Enrollment ID: I20240319002204 |
| Provider Name | Brett A Hooker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083485379 PECOS PAC ID: 2466899349 Enrollment ID: I20240327002730 |
| Provider Name | Nicholas Rizzo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669447272 PECOS PAC ID: 7719018464 Enrollment ID: I20240410000673 |
| Provider Name | Philetus Kleinschmit |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1619539251 PECOS PAC ID: 3678908761 Enrollment ID: I20240425001808 |
| Provider Name | Ashley Dawn Ruiz |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1528822038 PECOS PAC ID: 8123460425 Enrollment ID: I20240531000151 |
| Provider Name | Allyson Nicole Dimagno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982224879 PECOS PAC ID: 5294156725 Enrollment ID: I20240606001846 |
| Provider Name | Jacob A Braddock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801470984 PECOS PAC ID: 5395147722 Enrollment ID: I20240613000540 |
| Provider Name | Julia Chapman |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1477579548 PECOS PAC ID: 5991756439 Enrollment ID: I20240702004442 |
| Provider Name | Elizabeth Marie Stockwell |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1871332353 PECOS PAC ID: 1052855707 Enrollment ID: I20240705000453 |
| Provider Name | Victoria T Drzyzga |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578142808 PECOS PAC ID: 6204236003 Enrollment ID: I20240709003043 |
| Provider Name | Melissa N Kessie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225615784 PECOS PAC ID: 0042674160 Enrollment ID: I20240710005022 |
| Provider Name | Ashley L Famillion |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376123893 PECOS PAC ID: 3274936471 Enrollment ID: I20240715001233 |
| Provider Name | Drew Michael S Donnell |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1447711866 PECOS PAC ID: 7719422526 Enrollment ID: I20240716002434 |
| Provider Name | Laura Kanyimbo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811744931 PECOS PAC ID: 9133665870 Enrollment ID: I20240718001926 |
| Provider Name | Kathrin M Parisi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1467073270 PECOS PAC ID: 1254752405 Enrollment ID: I20240720000236 |
| Provider Name | Amanda Marie Jackson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124466438 PECOS PAC ID: 7618244567 Enrollment ID: I20240723001978 |
| Provider Name | Jasmine Dhillon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255902169 PECOS PAC ID: 7012312531 Enrollment ID: I20240730001994 |
| Provider Name | John T Renzi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679140966 PECOS PAC ID: 8224438791 Enrollment ID: I20240730003951 |
| Provider Name | Alexa M Rozycki |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1881440022 PECOS PAC ID: 5193262863 Enrollment ID: I20240731002305 |
| Provider Name | Harmanjot Singh Khaira |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1205321536 PECOS PAC ID: 4284984105 Enrollment ID: I20240806002585 |
| Provider Name | Emilie K Harvey |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1447006556 PECOS PAC ID: 4688112139 Enrollment ID: I20240814004033 |
| Provider Name | Uchechukwu K Sampson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1154478949 PECOS PAC ID: 2365437068 Enrollment ID: I20240820002636 |
| Provider Name | Kathleen George |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194305474 PECOS PAC ID: 7214337823 Enrollment ID: I20240820003739 |
| Provider Name | Mary R Lacoursiere |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659864387 PECOS PAC ID: 7618219932 Enrollment ID: I20240821000556 |
| Provider Name | Jo Anna Frances Curless |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649933656 PECOS PAC ID: 0547709586 Enrollment ID: I20240822001423 |
| Provider Name | Rebecca J Crimmins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003655572 PECOS PAC ID: 6204375132 Enrollment ID: I20240823000618 |
| Provider Name | Courtney E Hart |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1861919888 PECOS PAC ID: 0749556199 Enrollment ID: I20240828001316 |
| Provider Name | Richard D Fessler |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1134641038 PECOS PAC ID: 7416228911 Enrollment ID: I20240909002901 |
| Provider Name | Nicole L Kunar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790149995 PECOS PAC ID: 1557656642 Enrollment ID: I20240910002181 |
| Provider Name | Ali Daneshmand |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619316650 PECOS PAC ID: 9436448289 Enrollment ID: I20241002001464 |
| Provider Name | Amanda Kate Lemmers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710722236 PECOS PAC ID: 3870024763 Enrollment ID: I20241002003159 |
| Provider Name | Rebecca Rochelle Mckown |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1225000847 PECOS PAC ID: 3274601786 Enrollment ID: I20241018000241 |
| Provider Name | Victoria Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861168460 PECOS PAC ID: 3072045590 Enrollment ID: I20241022001309 |
| Provider Name | Charrell W Thomas |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427195957 PECOS PAC ID: 3577631985 Enrollment ID: I20241026000121 |
| Provider Name | Erika L Dearing |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1144562075 PECOS PAC ID: 5092947317 Enrollment ID: I20241026000256 |
| Provider Name | Anna Weaver Grady |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1346653334 PECOS PAC ID: 3870719784 Enrollment ID: I20241031000370 |
| Provider Name | Waseem Barham |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1053540203 PECOS PAC ID: 5092966820 Enrollment ID: I20241119004631 |
| Provider Name | Lucinda Lou Kil Gillis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639908601 PECOS PAC ID: 2668906371 Enrollment ID: I20241126001134 |
| Provider Name | Esther Pokuaa Adu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598593287 PECOS PAC ID: 1355876152 Enrollment ID: I20241202003201 |
| Provider Name | Wendi Ciesielska |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063166585 PECOS PAC ID: 2062895428 Enrollment ID: I20241206001853 |
| Provider Name | Ryan Daniel Stoy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629899877 PECOS PAC ID: 3274069174 Enrollment ID: I20241214000399 |
| Provider Name | Thomas D Bussineau |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992155055 PECOS PAC ID: 7517250210 Enrollment ID: I20241220000209 |
| Provider Name | Timothy Johnson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1982085247 PECOS PAC ID: 7012213697 Enrollment ID: I20241226002550 |
| Provider Name | Yosef Kahn |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1255538898 PECOS PAC ID: 9739365032 Enrollment ID: I20241227001587 |
| Provider Name | Christopher Champlin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548791635 PECOS PAC ID: 2062781156 Enrollment ID: I20250117002179 |
| Provider Name | Leslie Kaniuk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245065127 PECOS PAC ID: 1557890571 Enrollment ID: I20250121001626 |
| Provider Name | Kevin M Major |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1457383366 PECOS PAC ID: 3870561830 Enrollment ID: I20250123001073 |
| Provider Name | Michelle F Kaufman |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1023553278 PECOS PAC ID: 1153605241 Enrollment ID: I20250218000451 |
| Provider Name | Leah Michelle Stover |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205691094 PECOS PAC ID: 1456871607 Enrollment ID: I20250219000804 |
| Provider Name | Venkata Anupama Narla |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1386801488 PECOS PAC ID: 8628296498 Enrollment ID: I20250227002248 |
| Provider Name | Heather A Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689429854 PECOS PAC ID: 9234543927 Enrollment ID: I20250314000768 |
| Provider Name | Felicia N Collins |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1639588460 PECOS PAC ID: 0547487530 Enrollment ID: I20250314002260 |
| Provider Name | Kelly Rae Vogel |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1386388809 PECOS PAC ID: 4385166131 Enrollment ID: I20250320003295 |
| Provider Name | Andriana Nadia Benge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487463139 PECOS PAC ID: 5890218705 Enrollment ID: I20250401003100 |
| Provider Name | Haitham Alabsi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1538587803 PECOS PAC ID: 7416279690 Enrollment ID: I20250408003680 |
| Provider Name | Forrest B Sheffield |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1669764957 PECOS PAC ID: 9830360007 Enrollment ID: I20250414003146 |
| Provider Name | Brian T Simmons |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1750371829 PECOS PAC ID: 7315924388 Enrollment ID: I20250415003511 |
| Provider Name | Luke Stephen Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720899883 PECOS PAC ID: 8729503644 Enrollment ID: I20250423000801 |
| Provider Name | Cheryl L Adams |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1730476227 PECOS PAC ID: 6305014606 Enrollment ID: I20250425001603 |
| Provider Name | Charles O Blades |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1134194228 PECOS PAC ID: 2961467006 Enrollment ID: I20250503000095 |
| Provider Name | Syed P Sattar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942314604 PECOS PAC ID: 3375500796 Enrollment ID: I20250522001979 |
| Provider Name | Alyssa Anne Goncalves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801665971 PECOS PAC ID: 0446603385 Enrollment ID: I20250612001194 |
Saint Joseph Regional Medical Center-south Bend Campus, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 611 E Douglas Rd, Ste 406, Family Medicine Faculty Physicians, Mishawaka, IN 46545 Phone: 574-335-6580 Fax: 574-335-0818 | |
Saint Joseph Pace Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 250 E Day Rd, Mishawaka, IN 46545 Phone: 574-247-8700 | |
Allied Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 314 W Catalpa Dr, Suite A, Mishawaka, IN 46545 Phone: 574-255-1522 Fax: 574-255-1540 | |
Honor Physicians, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3809 N Main St Ste 100, Mishawaka, IN 46545 Phone: 574-520-1700 Fax: 833-989-0916 | |
Novia Careclinics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 214 Indiana Ave, Mishawaka, IN 46544 Phone: 317-472-7568 Fax: 574-855-1565 | |
Saint Joseph Community Hospital Of Mishawaka Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 Lincoln Way W, Mishawaka, IN 46544 Phone: 574-252-3699 Fax: 574-252-3698 |