| Blessing Hospital | |
|
1005 Broadway St Quincy IL 62301-2834 | |
| (217) 223-8400 | |
| Not Available |
| Full Name | Blessing Hospital |
|---|---|
| Speciality | Clinic/Center |
| Location | 1005 Broadway St, Quincy, Illinois |
| Authorized Official Name and Position | Timothy Moore (VP, FINANCE, CAO) |
| Authorized Official Contact | 2172238400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blessing Hospital 1005 Broadway St Quincy IL 62301-2834 | Blessing Hospital 1005 Broadway St Quincy IL 62301-2834 Ph: (217) 223-8400 |
| NPI Number | 1114471737 |
|---|---|
| Provider Enumeration Date | 08/11/2016 |
| Last Update Date | 01/07/2021 |
| Certification Date | 01/07/2021 |
| Medicare PECOS PAC ID | 3072422534 |
|---|---|
| Medicare Enrollment ID | O20161005001836 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114471737 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Primary |
| 2085R0001X | Radiology - Radiation Oncology | 0000141 (Illinois) | Secondary |
| Provider Name | Idol R Mitchell |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1508850694 PECOS PAC ID: 6507763984 Enrollment ID: I20031215000432 |
| Provider Name | Alejandro Mendez Castillo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649255076 PECOS PAC ID: 2567361322 Enrollment ID: I20031231000416 |
| Provider Name | Joseph Judge |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841202462 PECOS PAC ID: 9931092202 Enrollment ID: I20040203000119 |
| Provider Name | Mark Khil |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1851398598 PECOS PAC ID: 9436048311 Enrollment ID: I20040311000130 |
| Provider Name | Alan Richard Obert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023116993 PECOS PAC ID: 5890686968 Enrollment ID: I20040320000520 |
| Provider Name | Jeffrey W Lerch |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124078795 PECOS PAC ID: 1355334335 Enrollment ID: I20040406000440 |
| Provider Name | Michael E Kirkpatrick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871517862 PECOS PAC ID: 2062493976 Enrollment ID: I20040526001500 |
| Provider Name | David C Lieber |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1558462408 PECOS PAC ID: 2860473543 Enrollment ID: I20040527001186 |
| Provider Name | Cesar Munoz |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1710979208 PECOS PAC ID: 8325023195 Enrollment ID: I20040624000245 |
| Provider Name | John Willis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326095670 PECOS PAC ID: 2567440175 Enrollment ID: I20040709001422 |
| Provider Name | Abby Reich |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700966124 PECOS PAC ID: 4284601394 Enrollment ID: I20040916000567 |
| Provider Name | Jacqueline a Treschuk-bahn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578533840 PECOS PAC ID: 5092778696 Enrollment ID: I20041104001044 |
| Provider Name | Salvador Sanchez Zuniga |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982799086 PECOS PAC ID: 4587628268 Enrollment ID: I20041112000568 |
| Provider Name | Barry a Werries |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1962481366 PECOS PAC ID: 6103895693 Enrollment ID: I20041130000412 |
| Provider Name | Steven Krause |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1386628519 PECOS PAC ID: 9234195884 Enrollment ID: I20041206000219 |
| Provider Name | James Won |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245340439 PECOS PAC ID: 2860445889 Enrollment ID: I20050301000961 |
| Provider Name | Pamela P Friye |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1639156383 PECOS PAC ID: 8325093479 Enrollment ID: I20050322000415 |
| Provider Name | Gina Dietrich |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1184648974 PECOS PAC ID: 2860448347 Enrollment ID: I20050328000968 |
| Provider Name | John D Hammock |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1912082975 PECOS PAC ID: 7618919101 Enrollment ID: I20050525000268 |
| Provider Name | Cesar Sobremonte Arguelles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518944248 PECOS PAC ID: 7012944036 Enrollment ID: I20050721000434 |
| Provider Name | Kelly J Rife |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942273883 PECOS PAC ID: 0749218600 Enrollment ID: I20050801001129 |
| Provider Name | William C Severino |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1659464493 PECOS PAC ID: 3173551777 Enrollment ID: I20050803000483 |
| Provider Name | Crystal L Perry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689682528 PECOS PAC ID: 8325078140 Enrollment ID: I20050822000089 |
| Provider Name | Ronald St Hill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316032147 PECOS PAC ID: 0648201822 Enrollment ID: I20050826000852 |
| Provider Name | Matthew Kuhn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992818991 PECOS PAC ID: 8426000324 Enrollment ID: I20050928001014 |
| Provider Name | Mohammed Memon |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1164577102 PECOS PAC ID: 9436104619 Enrollment ID: I20051013000614 |
| Provider Name | Madhu R Dukkipati |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1063436715 PECOS PAC ID: 1658398037 Enrollment ID: I20051025000628 |
| Provider Name | Syam Reddy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780652180 PECOS PAC ID: 1355361841 Enrollment ID: I20051129000711 |
| Provider Name | Irving L Schwartz |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831103092 PECOS PAC ID: 4880615558 Enrollment ID: I20051208000846 |
| Provider Name | Joseph Lane |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548485873 PECOS PAC ID: 6103848841 Enrollment ID: I20051222000316 |
| Provider Name | Loretta Anne Baustian |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1538153408 PECOS PAC ID: 4082637921 Enrollment ID: I20060106000325 |
| Provider Name | Claude J Fortin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1235225780 PECOS PAC ID: 8921904327 Enrollment ID: I20060109000228 |
| Provider Name | Venu Reddy |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1164429957 PECOS PAC ID: 3971592213 Enrollment ID: I20060207000034 |
| Provider Name | Melissa Kay Penn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255439105 PECOS PAC ID: 1153338009 Enrollment ID: I20060317000048 |
| Provider Name | Nanjappa C Somanna |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1306850615 PECOS PAC ID: 2264441369 Enrollment ID: I20060418000734 |
| Provider Name | Adnan Mushtaq |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1467409284 PECOS PAC ID: 8820093925 Enrollment ID: I20060925000068 |
| Provider Name | Vinod Alluri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548279870 PECOS PAC ID: 1254336357 Enrollment ID: I20060925000093 |
| Provider Name | Roula Y Tanios |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1205857141 PECOS PAC ID: 0143226936 Enrollment ID: I20061019000050 |
| Provider Name | John R S Deguzman |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1376567354 PECOS PAC ID: 1658378922 Enrollment ID: I20061030000225 |
| Provider Name | Pierre E Raad |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1407877418 PECOS PAC ID: 1557368834 Enrollment ID: I20061030000239 |
| Provider Name | Hisham Youssef |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720078629 PECOS PAC ID: 8325140346 Enrollment ID: I20070222000289 |
| Provider Name | Asad Rafiq |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1295879666 PECOS PAC ID: 5799887170 Enrollment ID: I20070305000162 |
| Provider Name | Amir N Cheema |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1386707750 PECOS PAC ID: 2163525072 Enrollment ID: I20070314000402 |
| Provider Name | Darr W Leutz |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1225069057 PECOS PAC ID: 2567564438 Enrollment ID: I20070320000170 |
| Provider Name | Daniel L Moore |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1750576641 PECOS PAC ID: 6204923998 Enrollment ID: I20071026000665 |
| Provider Name | Erica Marie Miller Spears |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1902093123 PECOS PAC ID: 5395832513 Enrollment ID: I20071103000083 |
| Provider Name | Pierre S Charles |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1457369480 PECOS PAC ID: 5294818712 Enrollment ID: I20080211000058 |
| Provider Name | Daniel a Liesen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1386747731 PECOS PAC ID: 1658458823 Enrollment ID: I20080411000560 |
| Provider Name | Jennifer A. Holcomb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639330400 PECOS PAC ID: 8729153457 Enrollment ID: I20080814000750 |
| Provider Name | Jeffrey R Cook |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1952353518 PECOS PAC ID: 1254483480 Enrollment ID: I20090717000509 |
| Provider Name | Chad a Noggle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063654796 PECOS PAC ID: 6709938673 Enrollment ID: I20090723000711 |
| Provider Name | Gregory Henkle |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649408030 PECOS PAC ID: 5496808370 Enrollment ID: I20090727000145 |
| Provider Name | Christie Nicole Stewart |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356676704 PECOS PAC ID: 4385782457 Enrollment ID: I20091110000447 |
| Provider Name | Christian Zwick |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1801869060 PECOS PAC ID: 5496843526 Enrollment ID: I20100116000391 |
| Provider Name | Duane Anthony Hanzel |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1467442251 PECOS PAC ID: 5597807784 Enrollment ID: I20100127000040 |
| Provider Name | Lee Roy W Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841385937 PECOS PAC ID: 8820124886 Enrollment ID: I20100329000902 |
| Provider Name | Kia Sherise Boxley-gillespie |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477655686 PECOS PAC ID: 8325174121 Enrollment ID: I20100331000725 |
| Provider Name | Bruce Stoops |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073738324 PECOS PAC ID: 1456489632 Enrollment ID: I20100507000790 |
| Provider Name | Todd H Petty |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1649243924 PECOS PAC ID: 5496805335 Enrollment ID: I20100521000504 |
| Provider Name | Jack Lyons |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104877851 PECOS PAC ID: 0446143804 Enrollment ID: I20100728001027 |
| Provider Name | Wesley D Creech |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1548424567 PECOS PAC ID: 3173690757 Enrollment ID: I20101014000228 |
| Provider Name | Srinivas R Puli |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1326069824 PECOS PAC ID: 7416928593 Enrollment ID: I20101019001417 |
| Provider Name | Lanny E Stiles |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508951781 PECOS PAC ID: 1759576549 Enrollment ID: I20101105000728 |
| Provider Name | Lisa Simone Herzing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912210378 PECOS PAC ID: 8921280892 Enrollment ID: I20110314000791 |
| Provider Name | Mary F Barthel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194729087 PECOS PAC ID: 5294893434 Enrollment ID: I20111006000719 |
| Provider Name | Albert J Song |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952563546 PECOS PAC ID: 1153513254 Enrollment ID: I20111025000312 |
| Provider Name | Joy Bockhold |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215163597 PECOS PAC ID: 2567629884 Enrollment ID: I20120127000950 |
| Provider Name | Nicollette Marie Haubrich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619212107 PECOS PAC ID: 2466607882 Enrollment ID: I20130308000305 |
| Provider Name | Charone T Tolbert |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033386461 PECOS PAC ID: 6305988361 Enrollment ID: I20130417000299 |
| Provider Name | Luc Tchapnda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801044763 PECOS PAC ID: 3779750310 Enrollment ID: I20130503000320 |
| Provider Name | Harsha V Polavarapu |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1982864476 PECOS PAC ID: 9133368251 Enrollment ID: I20130621000474 |
| Provider Name | Randy Balmforth |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366642738 PECOS PAC ID: 0244480739 Enrollment ID: I20130626000577 |
| Provider Name | Schvon Cummings |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225297807 PECOS PAC ID: 1759548779 Enrollment ID: I20140130000750 |
| Provider Name | Thejeswi Pujar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407008055 PECOS PAC ID: 1254457732 Enrollment ID: I20140528000001 |
| Provider Name | Bejoy John |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619285442 PECOS PAC ID: 4587881313 Enrollment ID: I20140819000231 |
| Provider Name | Ashley Akhtar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801216064 PECOS PAC ID: 2668690694 Enrollment ID: I20140904000595 |
| Provider Name | Ashley Mae Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235534066 PECOS PAC ID: 8921324070 Enrollment ID: I20150306002267 |
| Provider Name | Lyndell Lomax |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639560410 PECOS PAC ID: 5890012843 Enrollment ID: I20150331002608 |
| Provider Name | Jessica Curry |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1467741355 PECOS PAC ID: 4082927231 Enrollment ID: I20150717001122 |
| Provider Name | Rebecca a Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053797258 PECOS PAC ID: 5597070813 Enrollment ID: I20150817000543 |
| Provider Name | Prashanth Podaralla |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1730226952 PECOS PAC ID: 5496886699 Enrollment ID: I20150820012020 |
| Provider Name | Brian Robert Snyder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558380584 PECOS PAC ID: 4284601451 Enrollment ID: I20150903002464 |
| Provider Name | Sara Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720352180 PECOS PAC ID: 9234374794 Enrollment ID: I20151012000257 |
| Provider Name | Kelli Lunt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821420779 PECOS PAC ID: 5294045936 Enrollment ID: I20151109000460 |
| Provider Name | Shanti P Subbarao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487910295 PECOS PAC ID: 9638484850 Enrollment ID: I20151130001274 |
| Provider Name | Gayatri Sonti |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1295905107 PECOS PAC ID: 6204981822 Enrollment ID: I20160127002715 |
| Provider Name | Kerri L Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447611009 PECOS PAC ID: 3375833098 Enrollment ID: I20160608000511 |
| Provider Name | Emmanuel P Bessay |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1881914315 PECOS PAC ID: 0648562082 Enrollment ID: I20160706000700 |
| Provider Name | Gurdarshan Sandhu |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1083902852 PECOS PAC ID: 1456528926 Enrollment ID: I20160817000026 |
| Provider Name | Brian T Bamer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447683487 PECOS PAC ID: 4284955030 Enrollment ID: I20160822001502 |
| Provider Name | Rochell G Sharpe-hultz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215481247 PECOS PAC ID: 1557657616 Enrollment ID: I20160915002307 |
| Provider Name | Shanna J Dierker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558728337 PECOS PAC ID: 6406154608 Enrollment ID: I20160927002680 |
| Provider Name | Diana Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033669817 PECOS PAC ID: 5597043182 Enrollment ID: I20161102001671 |
| Provider Name | Nickolas J Gillette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598074353 PECOS PAC ID: 1658543160 Enrollment ID: I20161116000945 |
| Provider Name | Richard Berger |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780683003 PECOS PAC ID: 0749276491 Enrollment ID: I20161201000104 |
| Provider Name | Robert Johnson |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1053308825 PECOS PAC ID: 9436142668 Enrollment ID: I20161207000573 |
| Provider Name | Tushar Advani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881918415 PECOS PAC ID: 9739461484 Enrollment ID: I20170113000145 |
| Provider Name | Rick Knochel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033659081 PECOS PAC ID: 4486939329 Enrollment ID: I20170316000615 |
| Provider Name | Julie Eftink |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275926610 PECOS PAC ID: 7719263714 Enrollment ID: I20170405001331 |
| Provider Name | Myron B. Jones |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1225106420 PECOS PAC ID: 6204928492 Enrollment ID: I20170613002337 |
| Provider Name | Aphrodite Henderson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1861471450 PECOS PAC ID: 0547302366 Enrollment ID: I20170717000414 |
| Provider Name | Melissa Matrisch |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1811215064 PECOS PAC ID: 3476861568 Enrollment ID: I20170717002826 |
| Provider Name | Michael Behrens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194255083 PECOS PAC ID: 3476824095 Enrollment ID: I20170801000032 |
| Provider Name | Patricia Hirner |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1114906716 PECOS PAC ID: 6305986969 Enrollment ID: I20170802003094 |
| Provider Name | Michael C Burke |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962761742 PECOS PAC ID: 5092080028 Enrollment ID: I20171002001344 |
| Provider Name | Jessica E Althide |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366960130 PECOS PAC ID: 4385910223 Enrollment ID: I20171020002789 |
| Provider Name | Christopher Doedtman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427568732 PECOS PAC ID: 4981960689 Enrollment ID: I20171130000538 |
| Provider Name | Lowell Johnston Helmke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528584208 PECOS PAC ID: 0345508628 Enrollment ID: I20171213003311 |
| Provider Name | Bhagirath H Katbamna |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1447239041 PECOS PAC ID: 5395889679 Enrollment ID: I20180123001178 |
| Provider Name | Sarkis Marcel Nazarian |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1891806782 PECOS PAC ID: 4981835477 Enrollment ID: I20180215001020 |
| Provider Name | Diane Nutter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295708113 PECOS PAC ID: 7214920107 Enrollment ID: I20180222002388 |
| Provider Name | Brittany Egley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114457330 PECOS PAC ID: 5890064844 Enrollment ID: I20180228001164 |
| Provider Name | Jolinn Tripp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275060154 PECOS PAC ID: 4385905264 Enrollment ID: I20180312000828 |
| Provider Name | Kelsi D Cunningham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023531142 PECOS PAC ID: 2769744986 Enrollment ID: I20180327001977 |
| Provider Name | Lori George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205330669 PECOS PAC ID: 4587927876 Enrollment ID: I20180419001959 |
| Provider Name | Amy Lee Bates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255836326 PECOS PAC ID: 8628333903 Enrollment ID: I20180608000009 |
| Provider Name | Jason Mitchell Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255835237 PECOS PAC ID: 7810243136 Enrollment ID: I20180628002481 |
| Provider Name | Kelsey Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952899940 PECOS PAC ID: 7416204698 Enrollment ID: I20180718003829 |
| Provider Name | Joy M Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558853143 PECOS PAC ID: 2264780626 Enrollment ID: I20180802000078 |
| Provider Name | Jennifer Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336697010 PECOS PAC ID: 8325397938 Enrollment ID: I20180815001219 |
| Provider Name | Elise Scoggin |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1023420361 PECOS PAC ID: 1052537313 Enrollment ID: I20180821003499 |
| Provider Name | Kristi Michelle Gillette |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386999001 PECOS PAC ID: 2860712544 Enrollment ID: I20180927002743 |
| Provider Name | Elton J Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679526784 PECOS PAC ID: 1759487614 Enrollment ID: I20181113001187 |
| Provider Name | Rhonda Lampen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760412621 PECOS PAC ID: 2163477308 Enrollment ID: I20181113001463 |
| Provider Name | Suraya Kawadry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336431667 PECOS PAC ID: 4284938358 Enrollment ID: I20181113001808 |
| Provider Name | Douglas M Ikelheimer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508979519 PECOS PAC ID: 1759347396 Enrollment ID: I20181113001982 |
| Provider Name | Annette Yvonne Oetken |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952461782 PECOS PAC ID: 4486695459 Enrollment ID: I20181212001671 |
| Provider Name | Matthew J Stalker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669490090 PECOS PAC ID: 9739114349 Enrollment ID: I20181214001592 |
| Provider Name | Erin Bowers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053883140 PECOS PAC ID: 7113264920 Enrollment ID: I20190131001482 |
| Provider Name | Erik J Meidl |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891774469 PECOS PAC ID: 4183764459 Enrollment ID: I20190218000220 |
| Provider Name | Alexis Niemann Kirner |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1164959862 PECOS PAC ID: 5799040614 Enrollment ID: I20190311002425 |
| Provider Name | Kamal Akhtar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720543838 PECOS PAC ID: 2769722065 Enrollment ID: I20190410000139 |
| Provider Name | Laura Hull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609335116 PECOS PAC ID: 7113268582 Enrollment ID: I20190411002131 |
| Provider Name | Stacy Lowary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093274524 PECOS PAC ID: 2264774504 Enrollment ID: I20190507000547 |
| Provider Name | Brian Anderson |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1932465689 PECOS PAC ID: 9830330018 Enrollment ID: I20190618002692 |
| Provider Name | Mark Robert Wavrunek |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1194107607 PECOS PAC ID: 4981998390 Enrollment ID: I20190719002626 |
| Provider Name | Adam Lang |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1255716403 PECOS PAC ID: 3375879067 Enrollment ID: I20190802000849 |
| Provider Name | Josue Acevedo |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1427325034 PECOS PAC ID: 8224304043 Enrollment ID: I20190912001455 |
| Provider Name | Amanda Rose Platt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376109488 PECOS PAC ID: 5092045674 Enrollment ID: I20190924003297 |
| Provider Name | Bryson Thomas Whalen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1255727301 PECOS PAC ID: 9436468428 Enrollment ID: I20191011000682 |
| Provider Name | Kyla R Shultz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689169575 PECOS PAC ID: 0345597175 Enrollment ID: I20191111001635 |
| Provider Name | Nichole Stanley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851938476 PECOS PAC ID: 2365877214 Enrollment ID: I20200122003020 |
| Provider Name | Randi N. Donaldson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528627007 PECOS PAC ID: 7719313329 Enrollment ID: I20200130000285 |
| Provider Name | Pervez a Alvi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1932160348 PECOS PAC ID: 8022065234 Enrollment ID: I20200203000885 |
| Provider Name | Fernando Bonanni |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1720080864 PECOS PAC ID: 8921903881 Enrollment ID: I20200211001904 |
| Provider Name | Lisa Marie Orton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386274843 PECOS PAC ID: 6608203880 Enrollment ID: I20200228000040 |
| Provider Name | Laura Starman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720618457 PECOS PAC ID: 8527496850 Enrollment ID: I20200319000528 |
| Provider Name | Lauren Brandenburger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942668819 PECOS PAC ID: 6709184617 Enrollment ID: I20200326000991 |
| Provider Name | Kara C Moon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780177931 PECOS PAC ID: 6709215288 Enrollment ID: I20200403002239 |
| Provider Name | Mark R Mount |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1811950264 PECOS PAC ID: 7416921945 Enrollment ID: I20200418000297 |
| Provider Name | Elizabeth Ann Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669004081 PECOS PAC ID: 8820429384 Enrollment ID: I20200516000419 |
| Provider Name | Alexis L Schantz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386265551 PECOS PAC ID: 2668894866 Enrollment ID: I20200616003450 |
| Provider Name | Julie Michelle Livingston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043776958 PECOS PAC ID: 1951724053 Enrollment ID: I20200708001859 |
| Provider Name | Hannah Lee Haubrich |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1205453859 PECOS PAC ID: 3274956875 Enrollment ID: I20200714002927 |
| Provider Name | Alvin Joseph Gonzales Dandan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174835706 PECOS PAC ID: 3274836721 Enrollment ID: I20200805000204 |
| Provider Name | Bryan J Pimlott |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1396761318 PECOS PAC ID: 9739138009 Enrollment ID: I20200912000027 |
| Provider Name | William a Andel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821048372 PECOS PAC ID: 2163598897 Enrollment ID: I20200922001448 |
| Provider Name | Farooq Junaid |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1720328842 PECOS PAC ID: 6305138132 Enrollment ID: I20200928002947 |
| Provider Name | Kent L Snowden |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1558444646 PECOS PAC ID: 3476449562 Enrollment ID: I20201007000811 |
| Provider Name | Torre L Craine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417411786 PECOS PAC ID: 5193145183 Enrollment ID: I20201013001133 |
| Provider Name | Oleg Yurevich |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1326482571 PECOS PAC ID: 6305183542 Enrollment ID: I20201103000964 |
| Provider Name | Olivia Louise Patterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932716925 PECOS PAC ID: 6709296445 Enrollment ID: I20201107000000 |
| Provider Name | Andrea Nikole Leezer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710593124 PECOS PAC ID: 2668883299 Enrollment ID: I20201202002633 |
| Provider Name | Eric Colton |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1790723492 PECOS PAC ID: 0244271245 Enrollment ID: I20201214002071 |
| Provider Name | Veronica Lynn Roth-phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699376202 PECOS PAC ID: 5395157978 Enrollment ID: I20201228000036 |
| Provider Name | Brenda Blickhan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063000719 PECOS PAC ID: 1557775590 Enrollment ID: I20210202002051 |
| Provider Name | Jamie Lorraine Evans |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962664789 PECOS PAC ID: 6901044379 Enrollment ID: I20210208001928 |
| Provider Name | Gregory P Mclennan |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1912160052 PECOS PAC ID: 8628209327 Enrollment ID: I20210215001511 |
| Provider Name | Sonia L Behrens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629534227 PECOS PAC ID: 5294140240 Enrollment ID: I20210224002614 |
| Provider Name | Angela Riutzel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215529425 PECOS PAC ID: 2466868914 Enrollment ID: I20210308001170 |
| Provider Name | Daniel Koh |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1306946033 PECOS PAC ID: 6406807965 Enrollment ID: I20210317000473 |
| Provider Name | Michael Jones |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1972523991 PECOS PAC ID: 2668527961 Enrollment ID: I20210329000900 |
| Provider Name | Herman Leung |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346770377 PECOS PAC ID: 5597035709 Enrollment ID: I20210331001751 |
| Provider Name | Muhammad Iqbal |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1548249931 PECOS PAC ID: 2062431547 Enrollment ID: I20210331002350 |
| Provider Name | Erin Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972190510 PECOS PAC ID: 8820406416 Enrollment ID: I20210420002246 |
| Provider Name | Francis Le |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1134236508 PECOS PAC ID: 3476596925 Enrollment ID: I20210517001509 |
| Provider Name | Alicia Anne Reis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083296396 PECOS PAC ID: 7618376450 Enrollment ID: I20210526003149 |
| Provider Name | Carla Ramas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356676431 PECOS PAC ID: 8628260262 Enrollment ID: I20210607000873 |
| Provider Name | Bradley Holland |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1578910741 PECOS PAC ID: 7911290465 Enrollment ID: I20210623001742 |
| Provider Name | Dacon Scott |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1699395020 PECOS PAC ID: 6002217338 Enrollment ID: I20210624001326 |
| Provider Name | Valerie Hunter |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629052444 PECOS PAC ID: 4082512645 Enrollment ID: I20210629000647 |
| Provider Name | Ahmed Jouan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1043766314 PECOS PAC ID: 1557764909 Enrollment ID: I20210723000439 |
| Provider Name | Laurel Sexton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205405883 PECOS PAC ID: 6507260353 Enrollment ID: I20210802002349 |
| Provider Name | Umama Adil |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1033524368 PECOS PAC ID: 7416255112 Enrollment ID: I20210804002269 |
| Provider Name | Todd Klausner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407821283 PECOS PAC ID: 0244226280 Enrollment ID: I20210816001467 |
| Provider Name | Mohammadali Mojarrad |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487035887 PECOS PAC ID: 9931494069 Enrollment ID: I20210908003560 |
| Provider Name | Tariq Hussni Ali Enezate |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1154600492 PECOS PAC ID: 6709010937 Enrollment ID: I20211020001229 |
| Provider Name | Aparna Devi Yepuri |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699205229 PECOS PAC ID: 5890183925 Enrollment ID: I20211022000980 |
| Provider Name | Brett Genenbacher |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1467074401 PECOS PAC ID: 1355739301 Enrollment ID: I20211026000149 |
| Provider Name | Haritha Yepuri |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265919146 PECOS PAC ID: 5092064717 Enrollment ID: I20211026002265 |
| Provider Name | Dawn Elizabeth Koch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124601695 PECOS PAC ID: 7517356249 Enrollment ID: I20211117002686 |
| Provider Name | Arshad Muzaffar |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1881621001 PECOS PAC ID: 4284620717 Enrollment ID: I20220310000235 |
| Provider Name | Katyann Lucey |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1679143770 PECOS PAC ID: 4385046747 Enrollment ID: I20220319000162 |
| Provider Name | Megha E Garg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871695049 PECOS PAC ID: 9234213075 Enrollment ID: I20220325002077 |
| Provider Name | Ivan N Trinh |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1770917940 PECOS PAC ID: 2062706336 Enrollment ID: I20220421001590 |
| Provider Name | Milton Ochieng' |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1477717080 PECOS PAC ID: 8628292901 Enrollment ID: I20220518001717 |
| Provider Name | Brett Mcgowan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1023434347 PECOS PAC ID: 2961700190 Enrollment ID: I20220603001830 |
| Provider Name | John T Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144960493 PECOS PAC ID: 8729467063 Enrollment ID: I20220616002685 |
| Provider Name | Mary Fahrmeier |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245252303 PECOS PAC ID: 4880657527 Enrollment ID: I20220720000119 |
| Provider Name | Laila Wang Holmes |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518974260 PECOS PAC ID: 3870597578 Enrollment ID: I20220729002871 |
| Provider Name | Sushant Kapoor |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558755587 PECOS PAC ID: 0446565055 Enrollment ID: I20220808001930 |
| Provider Name | Nidhi Gupta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033399860 PECOS PAC ID: 0446435523 Enrollment ID: I20220810003546 |
| Provider Name | Alborz Javadzadeh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134605496 PECOS PAC ID: 9335498963 Enrollment ID: I20220816000742 |
| Provider Name | Christopher Charles Trammell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881188464 PECOS PAC ID: 2860749637 Enrollment ID: I20220817000870 |
| Provider Name | Brittney Moore |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467094839 PECOS PAC ID: 4082016076 Enrollment ID: I20220817001065 |
| Provider Name | Tanner Craig Eiben |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710472964 PECOS PAC ID: 5597012393 Enrollment ID: I20220823001483 |
| Provider Name | Surya Theja Polavarapu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780242776 PECOS PAC ID: 7911230719 Enrollment ID: I20220915003056 |
| Provider Name | David M Hanrahan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033347125 PECOS PAC ID: 2163835398 Enrollment ID: I20221028000330 |
| Provider Name | Karen Severson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689787426 PECOS PAC ID: 0840364030 Enrollment ID: I20221028000829 |
| Provider Name | Justin Hartupee |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1053632422 PECOS PAC ID: 9537399266 Enrollment ID: I20221107001612 |
| Provider Name | Maggie L Lamborn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033641642 PECOS PAC ID: 9638442460 Enrollment ID: I20221129002822 |
| Provider Name | Nicolai Zhidkov |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1851811434 PECOS PAC ID: 7911277199 Enrollment ID: I20221213002960 |
| Provider Name | Jeremiah Brewer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679968697 PECOS PAC ID: 8426366378 Enrollment ID: I20221221002344 |
| Provider Name | Angelia Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619685450 PECOS PAC ID: 9739550575 Enrollment ID: I20230113001868 |
| Provider Name | Christina M Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548730286 PECOS PAC ID: 2668719204 Enrollment ID: I20230125000847 |
| Provider Name | Chassidy Mae Schroder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427754209 PECOS PAC ID: 2668847153 Enrollment ID: I20230414001831 |
| Provider Name | Christina Meddows Jackson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1407150337 PECOS PAC ID: 1951560192 Enrollment ID: I20230428001384 |
| Provider Name | Amber Curry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609438993 PECOS PAC ID: 8921463613 Enrollment ID: I20230502002950 |
| Provider Name | Bradley D Beswick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205542958 PECOS PAC ID: 1355707175 Enrollment ID: I20230522002213 |
| Provider Name | Amanda Lackey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194041855 PECOS PAC ID: 0345551602 Enrollment ID: I20230613002398 |
| Provider Name | Logan Lackey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740506419 PECOS PAC ID: 6901198639 Enrollment ID: I20230613003433 |
| Provider Name | Deseray Eve Aguirre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982232385 PECOS PAC ID: 0749656965 Enrollment ID: I20230803000674 |
| Provider Name | Scott Dalane |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1821436692 PECOS PAC ID: 4486997715 Enrollment ID: I20230824001209 |
| Provider Name | Pouyan Arman |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1679952071 PECOS PAC ID: 7618286063 Enrollment ID: I20230830001584 |
| Provider Name | Kristen Buerstatte |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1841535309 PECOS PAC ID: 7810132644 Enrollment ID: I20230912000449 |
| Provider Name | Catherine Rose Baker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639795552 PECOS PAC ID: 1355765926 Enrollment ID: I20230920001643 |
| Provider Name | Steven Sharp |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366890857 PECOS PAC ID: 9436443256 Enrollment ID: I20230922003698 |
| Provider Name | Christina E Wendt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497445662 PECOS PAC ID: 4284088386 Enrollment ID: I20231005001590 |
| Provider Name | Anne Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255956652 PECOS PAC ID: 9739595158 Enrollment ID: I20231005002199 |
| Provider Name | Jeffrey Pan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1760470322 PECOS PAC ID: 7911917398 Enrollment ID: I20231011001642 |
| Provider Name | Jonathan Jacob Allred |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467816652 PECOS PAC ID: 9436447182 Enrollment ID: I20231012000251 |
| Provider Name | Joseph Couvillon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053517516 PECOS PAC ID: 0547438160 Enrollment ID: I20231012000682 |
| Provider Name | Mark Reese |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700801453 PECOS PAC ID: 7214912500 Enrollment ID: I20231016000593 |
| Provider Name | David Park |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1356904866 PECOS PAC ID: 3274868468 Enrollment ID: I20231016001747 |
| Provider Name | Dale B Johnson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982690103 PECOS PAC ID: 3173413408 Enrollment ID: I20231018000206 |
| Provider Name | Nicholas Tolat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023577939 PECOS PAC ID: 4981070950 Enrollment ID: I20231018002489 |
| Provider Name | Jed a Santa Maria |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154642239 PECOS PAC ID: 6709056955 Enrollment ID: I20231019000553 |
| Provider Name | Nha Tran |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255539326 PECOS PAC ID: 1759537889 Enrollment ID: I20231020000891 |
| Provider Name | Omotola Ajibade |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841571841 PECOS PAC ID: 4789049057 Enrollment ID: I20231020001584 |
| Provider Name | David Riesz |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487629929 PECOS PAC ID: 7911989728 Enrollment ID: I20231023000400 |
| Provider Name | John Sullivan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952368557 PECOS PAC ID: 1557306198 Enrollment ID: I20231023000568 |
| Provider Name | Stephanie a Reddick |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013096106 PECOS PAC ID: 8628006574 Enrollment ID: I20231023001193 |
| Provider Name | Rob Reed |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467496331 PECOS PAC ID: 8022051960 Enrollment ID: I20231024000624 |
| Provider Name | Gregory Hall |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891858585 PECOS PAC ID: 5193970010 Enrollment ID: I20231024002968 |
| Provider Name | Joel Lin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295858439 PECOS PAC ID: 6204935646 Enrollment ID: I20231024003096 |
| Provider Name | Daniel Sileo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043273675 PECOS PAC ID: 9032385208 Enrollment ID: I20231026002675 |
| Provider Name | Benjamin Kotinsley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104076330 PECOS PAC ID: 0547400996 Enrollment ID: I20231030000154 |
| Provider Name | Peter Miller |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295991081 PECOS PAC ID: 1850537697 Enrollment ID: I20231102001850 |
| Provider Name | Neil S Shachter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942336516 PECOS PAC ID: 2860576980 Enrollment ID: I20231107002060 |
| Provider Name | Mark Ronchi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932170800 PECOS PAC ID: 9234234642 Enrollment ID: I20231114002415 |
| Provider Name | Matthew Zwick |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033157888 PECOS PAC ID: 0244293512 Enrollment ID: I20231206001129 |
| Provider Name | Anil Shashikant Bhavsar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508012634 PECOS PAC ID: 4789822297 Enrollment ID: I20231212001579 |
| Provider Name | Joshua James Byrd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922682350 PECOS PAC ID: 9436558616 Enrollment ID: I20231213003020 |
| Provider Name | Chelsea Wilson |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1982478103 PECOS PAC ID: 9638529910 Enrollment ID: I20231228002718 |
| Provider Name | Yuzhou Liu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386096535 PECOS PAC ID: 4789920067 Enrollment ID: I20240103003305 |
| Provider Name | Brook a Linenfelser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013153329 PECOS PAC ID: 2365893260 Enrollment ID: I20240104002531 |
| Provider Name | Mary R Harris |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811178072 PECOS PAC ID: 2062863855 Enrollment ID: I20240105001381 |
| Provider Name | Jane E Riter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639294093 PECOS PAC ID: 1850742263 Enrollment ID: I20240110003029 |
| Provider Name | Lacy Jo Nichols |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083361430 PECOS PAC ID: 1153773742 Enrollment ID: I20240119000073 |
| Provider Name | Tracy Prow |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174600472 PECOS PAC ID: 6507218724 Enrollment ID: I20240123003237 |
| Provider Name | Monica Martinez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720270200 PECOS PAC ID: 4981769684 Enrollment ID: I20240124004408 |
| Provider Name | Sara Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861145732 PECOS PAC ID: 9335526342 Enrollment ID: I20240201001754 |
| Provider Name | James Love |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073595310 PECOS PAC ID: 5890722482 Enrollment ID: I20240206004728 |
| Provider Name | Carrie Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912776022 PECOS PAC ID: 2062855919 Enrollment ID: I20240207001992 |
| Provider Name | Adam Moeck |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134515059 PECOS PAC ID: 7012212178 Enrollment ID: I20240216000173 |
| Provider Name | Ilsup Yoon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1215476155 PECOS PAC ID: 2769854009 Enrollment ID: I20240304001305 |
| Provider Name | Ryan Brennan |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1619111853 PECOS PAC ID: 3476787888 Enrollment ID: I20240319002643 |
| Provider Name | Nicole S Gellatly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831427467 PECOS PAC ID: 2860533148 Enrollment ID: I20240403002225 |
| Provider Name | Robert Reyes |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1356789622 PECOS PAC ID: 5395093744 Enrollment ID: I20240409001540 |
| Provider Name | Daniel Luu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841652716 PECOS PAC ID: 9436494119 Enrollment ID: I20240411003503 |
| Provider Name | Justin Boe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205925864 PECOS PAC ID: 5496754988 Enrollment ID: I20240416000477 |
| Provider Name | Eduardo Quinones |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376797084 PECOS PAC ID: 4981769387 Enrollment ID: I20240416003576 |
| Provider Name | Cynthia Benton Stearns |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366523235 PECOS PAC ID: 7517964562 Enrollment ID: I20240423000905 |
| Provider Name | Jason Chon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376702852 PECOS PAC ID: 7315090933 Enrollment ID: I20240424003413 |
| Provider Name | Sean P Moroze |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1861804304 PECOS PAC ID: 7618264607 Enrollment ID: I20240501001124 |
| Provider Name | Funmilayo Tade Adewale |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275066722 PECOS PAC ID: 3971851197 Enrollment ID: I20240514000387 |
| Provider Name | Shana L Clarkson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053952515 PECOS PAC ID: 3577905991 Enrollment ID: I20240530001011 |
| Provider Name | Adam Delgado |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568857985 PECOS PAC ID: 2860838026 Enrollment ID: I20240610002791 |
| Provider Name | Joshua Erik Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912329376 PECOS PAC ID: 2163964529 Enrollment ID: I20240613000311 |
| Provider Name | Trista Danielle Neisen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316789167 PECOS PAC ID: 1153865902 Enrollment ID: I20240703001660 |
| Provider Name | Lindsay M Demoss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942865977 PECOS PAC ID: 9830422625 Enrollment ID: I20240710001822 |
| Provider Name | Philippe Fernand Nyembo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578136925 PECOS PAC ID: 3971048075 Enrollment ID: I20240712003323 |
| Provider Name | Paul Ramirez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114248986 PECOS PAC ID: 4385868967 Enrollment ID: I20240722000037 |
| Provider Name | Daniel Boeder |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669039822 PECOS PAC ID: 0547596058 Enrollment ID: I20240816003776 |
| Provider Name | Gale B Rice |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1801178306 PECOS PAC ID: 4183162464 Enrollment ID: I20240817000555 |
| Provider Name | Kendall K Passmore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588495311 PECOS PAC ID: 3375082449 Enrollment ID: I20240903003799 |
| Provider Name | Destiny Craven |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861238479 PECOS PAC ID: 0840730867 Enrollment ID: I20240905001071 |
| Provider Name | Julius a Manu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386218378 PECOS PAC ID: 9830592500 Enrollment ID: I20240920002647 |
| Provider Name | Eugene Oh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184613135 PECOS PAC ID: 7618967480 Enrollment ID: I20240924002792 |
| Provider Name | Michael Cerullo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649345026 PECOS PAC ID: 8123045648 Enrollment ID: I20240928000354 |
| Provider Name | Michael C Kiely |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1295106805 PECOS PAC ID: 2961856208 Enrollment ID: I20241004001043 |
| Provider Name | John Leiner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962571596 PECOS PAC ID: 2264440403 Enrollment ID: I20241008002455 |
| Provider Name | Sandra Dempsey |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1124124870 PECOS PAC ID: 3476794959 Enrollment ID: I20241022002897 |
| Provider Name | Giovanni Guerrero Millare |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659448967 PECOS PAC ID: 5294050852 Enrollment ID: I20241107003331 |
| Provider Name | Lauro Amezcua-patino |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659364396 PECOS PAC ID: 1153385273 Enrollment ID: I20241114002575 |
| Provider Name | Nanci Mercer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306838776 PECOS PAC ID: 7911806427 Enrollment ID: I20241118000545 |
| Provider Name | Lawrence Volz |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1649264649 PECOS PAC ID: 6103838511 Enrollment ID: I20241206001521 |
| Provider Name | Lindsay Hoebing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114749603 PECOS PAC ID: 7416484068 Enrollment ID: I20241220002703 |
| Provider Name | Robert Brooks |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891229001 PECOS PAC ID: 5294003893 Enrollment ID: I20250211003766 |
| Provider Name | Svetoslav Hristov |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336333590 PECOS PAC ID: 5890819841 Enrollment ID: I20250217001193 |
| Provider Name | Nicholas C Silvester |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790049377 PECOS PAC ID: 1355750928 Enrollment ID: I20250303002084 |
| Provider Name | Christopher Florido |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1306372495 PECOS PAC ID: 3577839687 Enrollment ID: I20250313001576 |
| Provider Name | Maha Mumtaz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871164152 PECOS PAC ID: 7719380096 Enrollment ID: I20250318001293 |
| Provider Name | Tara Otto |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356509038 PECOS PAC ID: 8224289608 Enrollment ID: I20250416003097 |
| Provider Name | Owori B Mang'eni |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1992232144 PECOS PAC ID: 2961881040 Enrollment ID: I20250416003305 |
| Provider Name | Tony Maung |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851316954 PECOS PAC ID: 7315978186 Enrollment ID: I20250421002174 |
| Provider Name | Samuel S Song |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225150014 PECOS PAC ID: 4284890989 Enrollment ID: I20250421002303 |
| Provider Name | Benson D Tran |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902069537 PECOS PAC ID: 7315187184 Enrollment ID: I20250428003002 |
| Provider Name | Danny Eisenberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376594978 PECOS PAC ID: 4587658521 Enrollment ID: I20250507001143 |
| Provider Name | Christopher Jones |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1841610326 PECOS PAC ID: 2668894288 Enrollment ID: I20250609000509 |
| Provider Name | Stephen Savioli |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558774208 PECOS PAC ID: 9032431366 Enrollment ID: I20250613000803 |
| Provider Name | Annette Millie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740220086 PECOS PAC ID: 8729020177 Enrollment ID: I20250625002101 |
| Provider Name | Jaspreet Singh Batra |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134382237 PECOS PAC ID: 8729335757 Enrollment ID: I20250627003263 |
| Provider Name | Adesina Adedeji |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104560762 PECOS PAC ID: 6709390032 Enrollment ID: I20250709001993 |
| Provider Name | Jeffrey Walker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205036316 PECOS PAC ID: 1153587191 Enrollment ID: I20250710003548 |
| Provider Name | Christina Peterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467193128 PECOS PAC ID: 8921480047 Enrollment ID: I20250714001543 |
| Provider Name | Timothy Rowland |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265636211 PECOS PAC ID: 6204889041 Enrollment ID: I20250715000817 |
| Provider Name | Mohamed Hatab |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558949578 PECOS PAC ID: 4284036211 Enrollment ID: I20250718000387 |
| Provider Name | Nikhil Banerjee |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1932424850 PECOS PAC ID: 0648561886 Enrollment ID: I20250721001107 |
| Provider Name | Muhammad a Arshid |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1043892631 PECOS PAC ID: 8426565276 Enrollment ID: I20250728001845 |
| Provider Name | Anne Wheeler Giuliano |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811938590 PECOS PAC ID: 2365489754 Enrollment ID: I20250809000303 |
| Provider Name | Cynthia Wallentin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265665707 PECOS PAC ID: 3678882867 Enrollment ID: I20250813002620 |
| Provider Name | Rodney Hutson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972506186 PECOS PAC ID: 1052493012 Enrollment ID: I20250814003818 |
| Provider Name | David Meredith Kerner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548641301 PECOS PAC ID: 8527349398 Enrollment ID: I20250815003299 |
| Provider Name | Justin Gross |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558676817 PECOS PAC ID: 1355573643 Enrollment ID: I20250819001256 |
| Provider Name | Kimberly Marlowe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699980615 PECOS PAC ID: 0143408757 Enrollment ID: I20250822002804 |
| Provider Name | Makenna Rathbun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174408082 PECOS PAC ID: 1355842717 Enrollment ID: I20250828002482 |
| Provider Name | William Hartz |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194721803 PECOS PAC ID: 7012810229 Enrollment ID: I20250828003164 |
| Provider Name | Justin Dodge |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1235112962 PECOS PAC ID: 6002960895 Enrollment ID: I20250911001692 |
| Provider Name | Snehal Mehta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699784272 PECOS PAC ID: 9931003456 Enrollment ID: I20250916003086 |
| Provider Name | James Wu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003242744 PECOS PAC ID: 3375815947 Enrollment ID: I20250919001501 |
| Provider Name | Umar Daud |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1053388942 PECOS PAC ID: 3476576703 Enrollment ID: I20251009001788 |
| Provider Name | Rakel Salamander |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629574611 PECOS PAC ID: 8224386743 Enrollment ID: I20251022001549 |
| Provider Name | Michael Bohnert |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1053990804 PECOS PAC ID: 2264833722 Enrollment ID: I20251106000789 |
| Provider Name | Anna Eslick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336910140 PECOS PAC ID: 6608213251 Enrollment ID: I20251107002045 |
| Provider Name | Kerem Ozturk |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275186280 PECOS PAC ID: 1052649704 Enrollment ID: I20251111001333 |
| Provider Name | Danyel Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932072568 PECOS PAC ID: 5890286454 Enrollment ID: I20251112001755 |
| Provider Name | Gregory Alexander Bortoff |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295768596 PECOS PAC ID: 6709771975 Enrollment ID: I20251117002475 |
| Provider Name | Robert P Henry |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619995628 PECOS PAC ID: 4981660800 Enrollment ID: I20251120000231 |
| Provider Name | Heidi Craddock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588680714 PECOS PAC ID: 3971404351 Enrollment ID: I20251202001615 |
| Provider Name | Luke White |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043848088 PECOS PAC ID: 5698190486 Enrollment ID: I20251209000863 |
| Provider Name | Addison Jacobs |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1679109482 PECOS PAC ID: 1254825342 Enrollment ID: I20251216002477 |
| Provider Name | Deepthi Gandhiraj |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1144621012 PECOS PAC ID: 6901183425 Enrollment ID: I20251216004609 |
| Provider Name | Philip James Kregor |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1598852600 PECOS PAC ID: 2466406301 Enrollment ID: I20251219000801 |
| Provider Name | Areeb Usmani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932779022 PECOS PAC ID: 9537561337 Enrollment ID: I20251224000928 |
| Provider Name | Henry Irvine |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780663609 PECOS PAC ID: 4183918527 Enrollment ID: I20251226000513 |
| Provider Name | Deenesh Sahajpal |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1952407967 PECOS PAC ID: 8325052129 Enrollment ID: I20260120000752 |
| Provider Name | Marshall Kong |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497916852 PECOS PAC ID: 5890919849 Enrollment ID: I20260213001765 |
| Provider Name | Haley R Bichsel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174335855 PECOS PAC ID: 2860975000 Enrollment ID: I20260316001660 |
| Provider Name | Nicholaus Monsma |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548755846 PECOS PAC ID: 9638413917 Enrollment ID: I20260326000991 |
| Provider Name | Kaela Marie Wellman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1508614355 PECOS PAC ID: 5294210035 Enrollment ID: I20260331000423 |
| Provider Name | Yen Hui Huang |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1164696779 PECOS PAC ID: 8527332725 Enrollment ID: I20260406002016 |
| Provider Name | Jamey Washburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023554029 PECOS PAC ID: 1355625476 Enrollment ID: I20260515000415 |
| Provider Name | Morris W Schaner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407886682 PECOS PAC ID: 5991713745 Enrollment ID: I20260520000396 |
| Provider Name | Kristin N Bradshaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568975183 PECOS PAC ID: 2567728074 Enrollment ID: I20260601000765 |
| Provider Name | Leslie N Henry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730010794 PECOS PAC ID: 8224500145 Enrollment ID: I20260611002811 |
| Provider Name | Kimberly S Darnell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780515841 PECOS PAC ID: 9436621307 Enrollment ID: I20260611004112 |
SIU Center for Family Medicine - Transitions of Western Illinois Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4409 Maine St Ste 100, Quincy, IL 62305 Phone: 217-919-9139 Fax: 217-223-0461 |
Blessing Express Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 420 N 34th St, Quincy, IL 62301 Phone: 217-214-9626 Fax: 217-214-9627 |
Blessing Convenient Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1400 Harrison St, Quincy, IL 62301 Phone: 217-223-8400 |
SIU Center for Family Medicine - Adams County Dental Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 330 Vermont St Ste 100, Quincy, IL 62301 Phone: 217-222-8440 Fax: 217-222-8508 |
Blessing Walk-in Clinic LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3700 Broadway St, Quincy, IL 62305 Phone: 217-228-1060 |
Blessing Fastcare Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3200 Broadway St, Quincy, IL 62301 Phone: 217-223-8400 Fax: 217-223-9945 |