| Chautauqua Medical Practice, P.c. | |
|
4936 Main St Bemus Point NY 14712 | |
| (716) 386-2414 | |
| (716) 386-2437 |
| Full Name | Chautauqua Medical Practice, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 4936 Main St, Bemus Point, New York |
| Authorized Official Name and Position | Paul S Holley (MD) |
| Authorized Official Contact | 7163862414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chautauqua Medical Practice, P.c. Po Box 470 4936 Main St Bemus Point NY 14712 Ph: (716) 386-2414 | Chautauqua Medical Practice, P.c. 4936 Main St Bemus Point NY 14712 Ph: (716) 386-2414 |
| NPI Number | 1922181767 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 09/30/2020 |
| Medicare PECOS PAC ID | 5294920203 |
|---|---|
| Medicare Enrollment ID | O20101116000137 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922181767 | NPI | - | NPPES |
| 01669929 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 204064 (New York) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Pararajasingham Yogeswaran |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1841210655 PECOS PAC ID: 0941245237 Enrollment ID: I20050627001276 |
| Provider Name | Paul S Holley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225015696 PECOS PAC ID: 5799735742 Enrollment ID: I20050809000868 |
| Provider Name | Melissa M Franckowiak |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1700077278 PECOS PAC ID: 1557457405 Enrollment ID: I20071023000687 |
| Provider Name | Adel Abas Mahmood Abdalla |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497702542 PECOS PAC ID: 8527053347 Enrollment ID: I20081112000846 |
| Provider Name | John Rosenberger |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467448050 PECOS PAC ID: 8123180700 Enrollment ID: I20081216000041 |
| Provider Name | Russell Elwell |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1245269364 PECOS PAC ID: 9830113554 Enrollment ID: I20100302000652 |
| Provider Name | Alan L Glaser |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1710970298 PECOS PAC ID: 9335042126 Enrollment ID: I20100607000720 |
| Provider Name | Wayne T Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578549283 PECOS PAC ID: 2769381763 Enrollment ID: I20110105001102 |
| Provider Name | Frederick C Havko |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841275872 PECOS PAC ID: 2769382522 Enrollment ID: I20110414000087 |
| Provider Name | Ross C Peterson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1609854363 PECOS PAC ID: 3779553086 Enrollment ID: I20111107000179 |
| Provider Name | Jeffrey Peter Mcgovern |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1780651554 PECOS PAC ID: 9032156344 Enrollment ID: I20111219000391 |
| Provider Name | Vladislava Buntic |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1689796120 PECOS PAC ID: 8729188198 Enrollment ID: I20141114000104 |
| Provider Name | Jodi Lee Schielke |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134398845 PECOS PAC ID: 7416173380 Enrollment ID: I20160614002273 |
| Provider Name | Lorenz H Schielke |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932146164 PECOS PAC ID: 4789574997 Enrollment ID: I20160621000603 |
| Provider Name | Susan Catherine Lee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225316847 PECOS PAC ID: 8325333081 Enrollment ID: I20170718000803 |
| Provider Name | Andrew J Kiskadden |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1104863018 PECOS PAC ID: 4385656479 Enrollment ID: I20170807000905 |
| Provider Name | Mark T Bloomstine |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1144285560 PECOS PAC ID: 9537130265 Enrollment ID: I20180619001014 |
| Provider Name | Charanjeet Singh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1235582610 PECOS PAC ID: 8325332851 Enrollment ID: I20190219001595 |
| Provider Name | Krista L Glaser |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1275527160 PECOS PAC ID: 0648210799 Enrollment ID: I20190308001130 |
| Provider Name | Nishant I Koradia |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1407039530 PECOS PAC ID: 0941373021 Enrollment ID: I20190523001728 |
| Provider Name | Jeffrey A Buetikofer |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1285612010 PECOS PAC ID: 4183520950 Enrollment ID: I20190530001196 |
| Provider Name | Safet Lekperic |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1104266691 PECOS PAC ID: 8527315142 Enrollment ID: I20190603000124 |
| Provider Name | Angela Marie Fast |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457693848 PECOS PAC ID: 6709141583 Enrollment ID: I20190604003190 |
| Provider Name | Alexandra Roudenko |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184068595 PECOS PAC ID: 6901130509 Enrollment ID: I20190702002213 |
| Provider Name | Holly Alexis Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588107031 PECOS PAC ID: 0042542532 Enrollment ID: I20191104000027 |
| Provider Name | Paul Karl Aldinger |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013206523 PECOS PAC ID: 2860764826 Enrollment ID: I20191204001344 |
| Provider Name | David Enoch Oppenheim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689671711 PECOS PAC ID: 5092703314 Enrollment ID: I20200102001315 |
| Provider Name | Matthew H Thomas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619970092 PECOS PAC ID: 8426020140 Enrollment ID: I20200109001812 |
| Provider Name | Keven Schattner |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1518916790 PECOS PAC ID: 0648230581 Enrollment ID: I20200723002258 |
| Provider Name | Kersthine Andre |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1710326293 PECOS PAC ID: 7012296130 Enrollment ID: I20200723002539 |
| Provider Name | Christina Payne |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1679912661 PECOS PAC ID: 8325394919 Enrollment ID: I20201116000358 |
| Provider Name | Paul Jerome Custodio |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1093997280 PECOS PAC ID: 8123306164 Enrollment ID: I20210303000988 |
| Provider Name | Luis Enrique Aguilera |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639412729 PECOS PAC ID: 5193072668 Enrollment ID: I20210318001825 |
| Provider Name | Jamie A Blatt |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1710278288 PECOS PAC ID: 8325225139 Enrollment ID: I20210423000529 |
| Provider Name | Priyanka Annigeri |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083026561 PECOS PAC ID: 3375842008 Enrollment ID: I20210720000252 |
| Provider Name | Brianna Aukland |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1710381900 PECOS PAC ID: 8325452816 Enrollment ID: I20210720001422 |
| Provider Name | Nitya Moothathu Bhalla |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356684021 PECOS PAC ID: 9133369291 Enrollment ID: I20210722001339 |
| Provider Name | Sherri Chafin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528052727 PECOS PAC ID: 7416853569 Enrollment ID: I20210722001529 |
| Provider Name | Bethany Casagranda |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659573236 PECOS PAC ID: 6507967353 Enrollment ID: I20210722001634 |
| Provider Name | David W Barker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275533341 PECOS PAC ID: 6800788969 Enrollment ID: I20210722001760 |
| Provider Name | Kyle Cothron |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1356667851 PECOS PAC ID: 3971897927 Enrollment ID: I20210722002064 |
| Provider Name | Larissa Casaburi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144386145 PECOS PAC ID: 9638170426 Enrollment ID: I20210722002067 |
| Provider Name | Joseph Delic |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578829503 PECOS PAC ID: 7416224159 Enrollment ID: I20210722002088 |
| Provider Name | Aaron Dunn |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1477896850 PECOS PAC ID: 7416202031 Enrollment ID: I20210722002289 |
| Provider Name | Georgine Demarino |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285664656 PECOS PAC ID: 5799698049 Enrollment ID: I20210722002502 |
| Provider Name | David Buck |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1053383760 PECOS PAC ID: 4981898624 Enrollment ID: I20210722003541 |
| Provider Name | Ronald Erdelyi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861887010 PECOS PAC ID: 6709195969 Enrollment ID: I20210723000320 |
| Provider Name | Warren Chang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851657209 PECOS PAC ID: 7618246778 Enrollment ID: I20210723001644 |
| Provider Name | Adam J Fang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285946434 PECOS PAC ID: 6406103381 Enrollment ID: I20210726001650 |
| Provider Name | Michael F Goldberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912056094 PECOS PAC ID: 5890868079 Enrollment ID: I20210727000876 |
| Provider Name | Juan Gonzalez Gaita |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326423914 PECOS PAC ID: 6002141736 Enrollment ID: I20210727001449 |
| Provider Name | Brian Goodman |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1063702082 PECOS PAC ID: 0648552471 Enrollment ID: I20210727003355 |
| Provider Name | Lulu He |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194017749 PECOS PAC ID: 7517256084 Enrollment ID: I20210803003495 |
| Provider Name | Tazeen Jamal |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285800649 PECOS PAC ID: 4981842135 Enrollment ID: I20210803003679 |
| Provider Name | Michael Howell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780901066 PECOS PAC ID: 8426369075 Enrollment ID: I20210804001487 |
| Provider Name | Kamyar Ilkhanipour |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285633933 PECOS PAC ID: 7416929955 Enrollment ID: I20210809001649 |
| Provider Name | Carmen Latona |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609840917 PECOS PAC ID: 2264470426 Enrollment ID: I20210816001316 |
| Provider Name | Matthew Kulzer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164658753 PECOS PAC ID: 0648503458 Enrollment ID: I20210816001352 |
| Provider Name | Andrew Klobuka |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073932984 PECOS PAC ID: 5597098210 Enrollment ID: I20210816001796 |
| Provider Name | Paul Kiproff |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1548269970 PECOS PAC ID: 3779555214 Enrollment ID: I20210816003162 |
| Provider Name | Paul Klepchick |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457429250 PECOS PAC ID: 6305997529 Enrollment ID: I20210818001354 |
| Provider Name | Anthony Lupetin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275532608 PECOS PAC ID: 1254303795 Enrollment ID: I20210907002532 |
| Provider Name | Charles Li |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487911103 PECOS PAC ID: 6204106982 Enrollment ID: I20210907002862 |
| Provider Name | Timothy Mickus |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114153855 PECOS PAC ID: 5395878201 Enrollment ID: I20210907002978 |
| Provider Name | Jason Long |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629207113 PECOS PAC ID: 6901045053 Enrollment ID: I20210908000109 |
| Provider Name | Matthew Miller |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811330061 PECOS PAC ID: 1153622022 Enrollment ID: I20210908000319 |
| Provider Name | Rishi Maheshwary |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316118367 PECOS PAC ID: 0345393377 Enrollment ID: I20210908000361 |
| Provider Name | Jeffrey S Mueller |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083663108 PECOS PAC ID: 2365487816 Enrollment ID: I20210929001519 |
| Provider Name | Brendan T Mullen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1245435940 PECOS PAC ID: 0143485870 Enrollment ID: I20210930000162 |
| Provider Name | Myles Mitsunaga |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1437577517 PECOS PAC ID: 5698005940 Enrollment ID: I20211006000163 |
| Provider Name | Barry O Parks |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578566980 PECOS PAC ID: 8325036304 Enrollment ID: I20211007001333 |
| Provider Name | Esther Park |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083095640 PECOS PAC ID: 7113282492 Enrollment ID: I20211007001385 |
| Provider Name | Abdullah A Shaikh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962617274 PECOS PAC ID: 7113063223 Enrollment ID: I20211007002026 |
| Provider Name | Brandon M Schooley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659589646 PECOS PAC ID: 8022101542 Enrollment ID: I20211007002917 |
| Provider Name | William M Peterson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1235366733 PECOS PAC ID: 0042456543 Enrollment ID: I20211008000040 |
| Provider Name | Efrain R Ochoa |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851566517 PECOS PAC ID: 5597881904 Enrollment ID: I20211008000406 |
| Provider Name | James E Oskin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871592196 PECOS PAC ID: 9335284165 Enrollment ID: I20211008000550 |
| Provider Name | Theodore C Schroeder |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588089247 PECOS PAC ID: 4688899727 Enrollment ID: I20211008000585 |
| Provider Name | Cody R Quirk |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023308541 PECOS PAC ID: 1355569062 Enrollment ID: I20211008002491 |
| Provider Name | Robin N Sobolewski |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972764215 PECOS PAC ID: 1254572258 Enrollment ID: I20211009000013 |
| Provider Name | Michael P Spearman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528060589 PECOS PAC ID: 2163447954 Enrollment ID: I20211011001709 |
| Provider Name | Alisa Sumkin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932545787 PECOS PAC ID: 2062767536 Enrollment ID: I20211011001912 |
| Provider Name | Suzanne G Shulman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1598899452 PECOS PAC ID: 3971603614 Enrollment ID: I20211012000120 |
| Provider Name | Sarah B Thomas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558771493 PECOS PAC ID: 2365777141 Enrollment ID: I20211012000406 |
| Provider Name | William C Thomeier |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689646770 PECOS PAC ID: 5496640088 Enrollment ID: I20211012000624 |
| Provider Name | Brian J Weston |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396123014 PECOS PAC ID: 2466717202 Enrollment ID: I20211012001501 |
| Provider Name | Jonathan M Potts |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1346249778 PECOS PAC ID: 4789656224 Enrollment ID: I20211012001561 |
| Provider Name | Tyson R Tragon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528487519 PECOS PAC ID: 9931499431 Enrollment ID: I20211013000108 |
| Provider Name | Luke A Treaster |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366838310 PECOS PAC ID: 0042639429 Enrollment ID: I20211013000129 |
| Provider Name | Christian P Wanamaker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841452240 PECOS PAC ID: 4789809823 Enrollment ID: I20211013000169 |
| Provider Name | Gaurav V Watane |
|---|---|
| Provider Type | Practitioner - Nuclear Medicine |
| Provider Identifiers | NPI Number: 1184170813 PECOS PAC ID: 7214208230 Enrollment ID: I20211013000214 |
| Provider Name | Burkhardt H Zorn |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1528026986 PECOS PAC ID: 1850341629 Enrollment ID: I20211013000390 |
| Provider Name | Zeba A Syed |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801874730 PECOS PAC ID: 3678500113 Enrollment ID: I20211013002735 |
| Provider Name | Mark J Scoggins |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326420076 PECOS PAC ID: 5597077933 Enrollment ID: I20211013003023 |
| Provider Name | Matthew S Hartman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003002783 PECOS PAC ID: 6507956612 Enrollment ID: I20211018002031 |
| Provider Name | Bhawana Rathore |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881859247 PECOS PAC ID: 6103080783 Enrollment ID: I20211018002867 |
| Provider Name | Peter O'connor |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720408461 PECOS PAC ID: 3274867932 Enrollment ID: I20211022002033 |
| Provider Name | Albert Sohn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1598021305 PECOS PAC ID: 4587929609 Enrollment ID: I20220831001892 |
| Provider Name | Aaron Meehl |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1992263495 PECOS PAC ID: 6800120643 Enrollment ID: I20230124001408 |
| Provider Name | Mark Anthony Becker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1598759714 PECOS PAC ID: 9234121427 Enrollment ID: I20230215002241 |
| Provider Name | David Olszewski |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1396126918 PECOS PAC ID: 5395050942 Enrollment ID: I20230216001999 |
| Provider Name | Jacob Tuttle |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1679065106 PECOS PAC ID: 6406107382 Enrollment ID: I20230224001908 |
| Provider Name | Layla Nasr |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841646262 PECOS PAC ID: 3678843380 Enrollment ID: I20230307002665 |
| Provider Name | Kevin Mccluskey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386744860 PECOS PAC ID: 0446359046 Enrollment ID: I20230307002718 |
| Provider Name | Michelle Pohland |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548351323 PECOS PAC ID: 8921172529 Enrollment ID: I20230307002863 |
| Provider Name | Francisca Oyedeji |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629394481 PECOS PAC ID: 9931499688 Enrollment ID: I20230308002116 |
| Provider Name | Edward R Scheid |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609827732 PECOS PAC ID: 4486689379 Enrollment ID: I20230308002154 |
| Provider Name | Prashanth Sompalli |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528421633 PECOS PAC ID: 0345530275 Enrollment ID: I20230308002489 |
| Provider Name | Benjamin Contrella |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649690058 PECOS PAC ID: 7719106632 Enrollment ID: I20230309000729 |
| Provider Name | Juan Ly Liu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528514171 PECOS PAC ID: 8820491749 Enrollment ID: I20230309000920 |
| Provider Name | Alan Podolsky |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477907764 PECOS PAC ID: 8123306396 Enrollment ID: I20230309001871 |
| Provider Name | Janet Tabas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639120744 PECOS PAC ID: 6305822669 Enrollment ID: I20230309001878 |
| Provider Name | William Terrill |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144617739 PECOS PAC ID: 7810275419 Enrollment ID: I20230309001950 |
| Provider Name | Jean Kimberly Rongo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1942656582 PECOS PAC ID: 6406226786 Enrollment ID: I20230310001481 |
| Provider Name | David Petrov |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518343797 PECOS PAC ID: 5991120933 Enrollment ID: I20230317001749 |
| Provider Name | Mark Colella |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780635896 PECOS PAC ID: 6103954581 Enrollment ID: I20230329002046 |
| Provider Name | David Huang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336374305 PECOS PAC ID: 0547312647 Enrollment ID: I20230330000790 |
| Provider Name | Benjamin Wardrop |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649627217 PECOS PAC ID: 9931487121 Enrollment ID: I20230404000253 |
| Provider Name | Scott Rudkin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629456108 PECOS PAC ID: 8820490006 Enrollment ID: I20230413000469 |
| Provider Name | Beth Pike |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1497149165 PECOS PAC ID: 5799096046 Enrollment ID: I20230607002538 |
| Provider Name | James Lane |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215913843 PECOS PAC ID: 1355240292 Enrollment ID: I20231102003411 |
| Provider Name | Ricardo Bello Martinez |
|---|---|
| Provider Type | Practitioner - Nuclear Medicine |
| Provider Identifiers | NPI Number: 1164945309 PECOS PAC ID: 3476899469 Enrollment ID: I20231109001466 |
| Provider Name | Daniel Hoffman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407380348 PECOS PAC ID: 7012274376 Enrollment ID: I20231116001158 |
| Provider Name | Ahmed M Fadl |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144510603 PECOS PAC ID: 2668742974 Enrollment ID: I20231116001591 |
| Provider Name | Anthony Miller |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699001974 PECOS PAC ID: 5092932277 Enrollment ID: I20231117000139 |
| Provider Name | William Lemley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801822721 PECOS PAC ID: 2264422625 Enrollment ID: I20231122000599 |
| Provider Name | Jitesh Dhingra |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326560764 PECOS PAC ID: 7810368404 Enrollment ID: I20231122002207 |
| Provider Name | Russell Cerejo |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265750715 PECOS PAC ID: 0648546028 Enrollment ID: I20240201004089 |
| Provider Name | Atman Dave |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134640253 PECOS PAC ID: 7113290289 Enrollment ID: I20240205004214 |
| Provider Name | Peter Ghobrial |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174797203 PECOS PAC ID: 3577705268 Enrollment ID: I20240208001561 |
| Provider Name | Konark Malhotra |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1831479633 PECOS PAC ID: 8820388903 Enrollment ID: I20240209001699 |
| Provider Name | Timothy Quezada |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1871942326 PECOS PAC ID: 8820386477 Enrollment ID: I20240219001324 |
| Provider Name | Sandeep Rana |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1871594283 PECOS PAC ID: 6608919089 Enrollment ID: I20240222000957 |