| Crusader Clinic | |
|
1200 W State St Rockford IL 61102-2112 | |
| (815) 490-1600 | |
| Not Available |
| Full Name | Crusader Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1200 W State St, Rockford, Illinois |
| Authorized Official Name and Position | Samuel Miller (PRESIDENT & CEO) |
| Authorized Official Contact | 8154901737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crusader Clinic 1200 W State St Rockford IL 61102-2112 Ph: (815) 490-1600 | Crusader Clinic 1200 W State St Rockford IL 61102-2112 Ph: (815) 490-1600 |
| NPI Number | 1902972557 |
|---|---|
| Provider Enumeration Date | 11/27/2006 |
| Last Update Date | 08/24/2022 |
| Medicare PECOS PAC ID | 5799682993 |
|---|---|
| Medicare Enrollment ID | O20031216000642 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902972557 | NPI | - | NPPES |
| 027548 | Other | CHAMPUS | |
| 101-15147-78 | Other | BLUE CROSS BLUE SHIELD | |
| 101319 | Other | IL | DORAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Scott R Homann |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1689674541 PECOS PAC ID: 0345220919 Enrollment ID: I20040723000357 |
| Provider Name | Antoun Y Al Khabbaz |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1992797260 PECOS PAC ID: 7517954548 Enrollment ID: I20061218000098 |
| Provider Name | Patricia J Nordman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225028350 PECOS PAC ID: 4981791753 Enrollment ID: I20071026000359 |
| Provider Name | Jennifer M Dobson |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1386712651 PECOS PAC ID: 5991866998 Enrollment ID: I20081209000781 |
| Provider Name | Edwin O Okeson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619951019 PECOS PAC ID: 5991998619 Enrollment ID: I20101026000387 |
| Provider Name | Sylvia A Garza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588800700 PECOS PAC ID: 8921280272 Enrollment ID: I20110308001021 |
| Provider Name | Kimberly A Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669606281 PECOS PAC ID: 9234383092 Enrollment ID: I20130131000541 |
| Provider Name | Amanda C Hahn |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1811244569 PECOS PAC ID: 0345494126 Enrollment ID: I20130201000178 |
| Provider Name | Renee L Keeney |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1205115383 PECOS PAC ID: 3072767466 Enrollment ID: I20130213000041 |
| Provider Name | Sadie A Rawajih |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1548669195 PECOS PAC ID: 1456673680 Enrollment ID: I20141125001416 |
| Provider Name | Stephanie M Rehberg |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1831562743 PECOS PAC ID: 8426340605 Enrollment ID: I20160708000234 |
| Provider Name | Victoria R Osborne |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1356885297 PECOS PAC ID: 0446531602 Enrollment ID: I20161229001423 |
| Provider Name | Amanda R Stone |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1790248110 PECOS PAC ID: 7113250804 Enrollment ID: I20190612001340 |
| Provider Name | Otavio Pereira Rodrigues |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1790125367 PECOS PAC ID: 0840421327 Enrollment ID: I20201007000699 |
| Provider Name | Rachel Clinic Bland |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1508462326 PECOS PAC ID: 8426463969 Enrollment ID: I20210330001790 |
| Provider Name | Carly S Kruse |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1144756438 PECOS PAC ID: 4284903188 Enrollment ID: I20210902000546 |
| Provider Name | Vanessa L Nienhouse |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1225561335 PECOS PAC ID: 9436428802 Enrollment ID: I20211011002145 |
| Provider Name | Paula Marin |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1235847724 PECOS PAC ID: 8729452404 Enrollment ID: I20230320002142 |
| Provider Name | Jennette Marie Hollister |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1164195699 PECOS PAC ID: 2466818836 Enrollment ID: I20230510002396 |
| Provider Name | Karen D Moses |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1922529627 PECOS PAC ID: 4981063757 Enrollment ID: I20230711004097 |
| Provider Name | May Samaan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1548823495 PECOS PAC ID: 3779937743 Enrollment ID: I20230925001781 |
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