| Bloomsdale Family Health Center | |
|
255 Boderman Bloomsdale MO 63627-9099 | |
| (573) 483-9492 | |
| Not Available |
| Full Name | Bloomsdale Family Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 255 Boderman, Bloomsdale, Missouri |
| Authorized Official Name and Position | Amanda Wolk (BUSINESS OFFICE DIRECTOR) |
| Authorized Official Contact | 5738837703 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloomsdale Family Health Center Po Box 366 Ste Genevieve MO 63670-0366 Ph: (573) 883-4477 | Bloomsdale Family Health Center 255 Boderman Bloomsdale MO 63627-9099 Ph: (573) 483-9492 |
| NPI Number | 1184658387 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 01/13/2023 |
| Medicare PECOS PAC ID | 3274432802 |
|---|---|
| Medicare Enrollment ID | O20040102000645 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184658387 | NPI | - | NPPES |
| CC8331 | Other | MO | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Kevin T Enger |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1376607564 PECOS PAC ID: 3971401688 Enrollment ID: I20031219000342 |
| Provider Name | Xiaohui Fan |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1245276252 PECOS PAC ID: 8224936463 Enrollment ID: I20031223000848 |
| Provider Name | Dale Kraenzle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437200649 PECOS PAC ID: 3779470901 Enrollment ID: I20040302001330 |
| Provider Name | Dan H Frissell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407829849 PECOS PAC ID: 8022093780 Enrollment ID: I20040618000828 |
| Provider Name | Srinivasan Raghavan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265444608 PECOS PAC ID: 5799760450 Enrollment ID: I20040618000865 |
| Provider Name | Gary R Goldstein |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1952392110 PECOS PAC ID: 6901870815 Enrollment ID: I20040825000470 |
| Provider Name | Jonathon Mark Bird |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568457463 PECOS PAC ID: 0840265351 Enrollment ID: I20040828000145 |
| Provider Name | Joseph W Sharlow |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1861466195 PECOS PAC ID: 3678479862 Enrollment ID: I20040921000230 |
| Provider Name | Tony Lam |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1093742314 PECOS PAC ID: 4284603176 Enrollment ID: I20040928000486 |
| Provider Name | Naman A Ghazal Albar |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1639144785 PECOS PAC ID: 7113970559 Enrollment ID: I20050225000549 |
| Provider Name | Matthew S Bosner |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1922088749 PECOS PAC ID: 8325082225 Enrollment ID: I20050613000213 |
| Provider Name | Gail L Craft |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043361264 PECOS PAC ID: 0749217032 Enrollment ID: I20050719000339 |
| Provider Name | Atif Shafqat |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1700991577 PECOS PAC ID: 9234169590 Enrollment ID: I20050816000861 |
| Provider Name | Holly A Huelskamp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336229202 PECOS PAC ID: 7911922216 Enrollment ID: I20051005001202 |
| Provider Name | Kenneth D Smith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316958531 PECOS PAC ID: 6103833512 Enrollment ID: I20061220000281 |
| Provider Name | Susan M Odonnell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720051162 PECOS PAC ID: 3678675170 Enrollment ID: I20070302000014 |
| Provider Name | Casey L Stahlheber |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1497950265 PECOS PAC ID: 4486754900 Enrollment ID: I20070713000117 |
| Provider Name | Joann Uding |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518089564 PECOS PAC ID: 6002974979 Enrollment ID: I20081021000631 |
| Provider Name | Briccio S Cadiz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932182722 PECOS PAC ID: 2264598648 Enrollment ID: I20090310000449 |
| Provider Name | Mary A Mccullough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396896510 PECOS PAC ID: 5092866434 Enrollment ID: I20090625000365 |
| Provider Name | Niranjana Raju |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700859394 PECOS PAC ID: 3476693029 Enrollment ID: I20091214000042 |
| Provider Name | Theresa A Cavins |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1710974019 PECOS PAC ID: 8123155256 Enrollment ID: I20100422000141 |
| Provider Name | Shamim Amini |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265486617 PECOS PAC ID: 3779586177 Enrollment ID: I20100605000176 |
| Provider Name | Jennifer H Smith |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1134237498 PECOS PAC ID: 0840322707 Enrollment ID: I20100713000611 |
| Provider Name | David L Weinstein |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043328305 PECOS PAC ID: 8022140987 Enrollment ID: I20100713000625 |
| Provider Name | Alan P Lyss |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013920651 PECOS PAC ID: 7416089081 Enrollment ID: I20100716000503 |
| Provider Name | Solomon Noguera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275516858 PECOS PAC ID: 2365424397 Enrollment ID: I20100729000596 |
| Provider Name | Michael Jeffrey Barkoviak |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1609867142 PECOS PAC ID: 4486620325 Enrollment ID: I20100823000439 |
| Provider Name | Mary E Crecelius |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841272861 PECOS PAC ID: 6406036508 Enrollment ID: I20110207000742 |
| Provider Name | Phillip L Kintner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578559084 PECOS PAC ID: 2365341278 Enrollment ID: I20110621000692 |
| Provider Name | Kelly A Donze |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1154636579 PECOS PAC ID: 4587833165 Enrollment ID: I20110816000838 |
| Provider Name | Chad Ronholm |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1306027909 PECOS PAC ID: 3678739307 Enrollment ID: I20120725000481 |
| Provider Name | Kimberly L Browne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710239496 PECOS PAC ID: 7618120684 Enrollment ID: I20121227000369 |
| Provider Name | Henry J Konzelmann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225022718 PECOS PAC ID: 0042123408 Enrollment ID: I20130430000141 |
| Provider Name | Racheal Lynn Whitaker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1316960529 PECOS PAC ID: 4385649839 Enrollment ID: I20131209000102 |
| Provider Name | Robin D Goff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639507957 PECOS PAC ID: 5597993105 Enrollment ID: I20140106000036 |
| Provider Name | Lacey E Sullivan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174951503 PECOS PAC ID: 5395973697 Enrollment ID: I20140113001307 |
| Provider Name | Kelly A Donze |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154636579 PECOS PAC ID: 4587833165 Enrollment ID: I20140113001719 |
| Provider Name | Regine E Politte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063813046 PECOS PAC ID: 2466673223 Enrollment ID: I20141020001092 |
| Provider Name | Anne K Wolk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639562028 PECOS PAC ID: 8820318785 Enrollment ID: I20150518001731 |
| Provider Name | Juliana C Verticchio |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1285999508 PECOS PAC ID: 1951530484 Enrollment ID: I20150716002867 |
| Provider Name | Kelli M Brockman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477818599 PECOS PAC ID: 4981918299 Enrollment ID: I20150730013107 |
| Provider Name | Julia G Hoffman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1477585669 PECOS PAC ID: 3274679816 Enrollment ID: I20160830002198 |
| Provider Name | Bridgette L Baer |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780791459 PECOS PAC ID: 4789963687 Enrollment ID: I20161117000513 |
| Provider Name | Melissa A Naeger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538616362 PECOS PAC ID: 0042590424 Enrollment ID: I20161130001108 |
| Provider Name | Zaki H Chowdhury |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366456022 PECOS PAC ID: 1456345669 Enrollment ID: I20161216000111 |
| Provider Name | Casey E Koller |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699167692 PECOS PAC ID: 7810264652 Enrollment ID: I20170525002028 |
| Provider Name | Elizabeth Wolk |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1861884744 PECOS PAC ID: 8123395977 Enrollment ID: I20170525002304 |
| Provider Name | Christina Marie Peters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851767149 PECOS PAC ID: 5294042925 Enrollment ID: I20170815002537 |
| Provider Name | John W Pipkin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346797305 PECOS PAC ID: 2163795097 Enrollment ID: I20170829000901 |
| Provider Name | Britney D Tarrillion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568987337 PECOS PAC ID: 8921371170 Enrollment ID: I20170908003148 |
| Provider Name | Deborah A Raney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851810444 PECOS PAC ID: 0648545889 Enrollment ID: I20171013001619 |
| Provider Name | Lisa Engle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437668969 PECOS PAC ID: 2567738081 Enrollment ID: I20171026003395 |
| Provider Name | Jacqueline M Wolk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144730615 PECOS PAC ID: 4688930092 Enrollment ID: I20171116003012 |
| Provider Name | Jessica M Levin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952898348 PECOS PAC ID: 0446514871 Enrollment ID: I20180510000804 |
| Provider Name | Erika Leung |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326453721 PECOS PAC ID: 0345542106 Enrollment ID: I20180710003037 |
| Provider Name | Elena May-plaza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730686700 PECOS PAC ID: 4284978453 Enrollment ID: I20181129002129 |
| Provider Name | Cristella P Torres |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609243013 PECOS PAC ID: 5193061117 Enrollment ID: I20190112000284 |
| Provider Name | Elle L Grither |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730743881 PECOS PAC ID: 0446682082 Enrollment ID: I20191119002979 |
| Provider Name | Enriqueta A Hill |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1982881009 PECOS PAC ID: 7618305830 Enrollment ID: I20200320001600 |
| Provider Name | Becky L Baumann |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1023400900 PECOS PAC ID: 3375971419 Enrollment ID: I20200324000182 |
| Provider Name | Matthew Stein |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1639589104 PECOS PAC ID: 6002230018 Enrollment ID: I20200723002096 |
| Provider Name | Kelly R Grein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407455421 PECOS PAC ID: 2860803467 Enrollment ID: I20201203001991 |
| Provider Name | Thomas M Castilaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588147623 PECOS PAC ID: 3476884446 Enrollment ID: I20210201002062 |
| Provider Name | Morgan Ritter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316529951 PECOS PAC ID: 7517362320 Enrollment ID: I20210817002353 |
| Provider Name | Robert D Bohnert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174293559 PECOS PAC ID: 3870984958 Enrollment ID: I20211228001105 |
| Provider Name | Aswin R Kansakar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467975573 PECOS PAC ID: 8022439660 Enrollment ID: I20220502000427 |
| Provider Name | Maryam Baikpour |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1023512720 PECOS PAC ID: 3870972532 Enrollment ID: I20220627001767 |
| Provider Name | Elizabeth M Ley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699416610 PECOS PAC ID: 9537549936 Enrollment ID: I20220701000539 |
| Provider Name | Katie Odom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194462010 PECOS PAC ID: 1658753124 Enrollment ID: I20220729002687 |
| Provider Name | Hannah E Kertz |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043716830 PECOS PAC ID: 8123373255 Enrollment ID: I20220927003684 |
| Provider Name | Deniane John |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881256014 PECOS PAC ID: 4981933439 Enrollment ID: I20220929000876 |
| Provider Name | Stephanie R Moll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588374698 PECOS PAC ID: 1658744313 Enrollment ID: I20230227002949 |
| Provider Name | Preston T Holifield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982397436 PECOS PAC ID: 7517326192 Enrollment ID: I20230629001269 |
| Provider Name | Abigail Fischer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861146557 PECOS PAC ID: 1052772563 Enrollment ID: I20230801000749 |
| Provider Name | Sarah Mariah Peth Bohnert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245857036 PECOS PAC ID: 0446673503 Enrollment ID: I20230913002899 |
Specialty Clinic At Bloomsdale Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 255 Boderman, Suite 2a, Bloomsdale, MO 63670 Phone: 573-883-4473 Fax: 573-883-4472 |