| Dba Castleton Family Health Center | |
|
275 Route 30 N Bomoseen VT 05732-9647 | |
| (802) 468-5641 | |
| (802) 468-2923 |
| Full Name | Dba Castleton Family Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 275 Route 30 N, Bomoseen, Vermont |
| Authorized Official Name and Position | Michael L Gardner (FINANCE DIRECTOR) |
| Authorized Official Contact | 8028552080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dba Castleton Family Health Center 71 Allen St Suite 101 Rutland VT 05701-4570 Ph: (800) 468-9118 | Dba Castleton Family Health Center 275 Route 30 N Bomoseen VT 05732-9647 Ph: (802) 468-5641 |
| NPI Number | 1336193838 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 06/21/2021 |
| Medicare PECOS PAC ID | 2961467386 |
|---|---|
| Medicare Enrollment ID | O20041129000357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336193838 | NPI | - | NPPES |
| 1010851 | Medicaid | VT | |
| 02940256 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Amy E. Ferguson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659395390 PECOS PAC ID: 8123921780 Enrollment ID: I20040130000291 |
| Provider Name | Robin Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609896604 PECOS PAC ID: 0042204943 Enrollment ID: I20040416000566 |
| Provider Name | Thomas Simpatico |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437234218 PECOS PAC ID: 2668454190 Enrollment ID: I20040607001024 |
| Provider Name | T Ray Lovko |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114982295 PECOS PAC ID: 8527046358 Enrollment ID: I20040709000048 |
| Provider Name | William B Bissell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447208269 PECOS PAC ID: 4981674348 Enrollment ID: I20040731000113 |
| Provider Name | Judy Nelson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1124152251 PECOS PAC ID: 6507832722 Enrollment ID: I20040908001140 |
| Provider Name | Bradley A Berryhill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699792614 PECOS PAC ID: 0840269544 Enrollment ID: I20040929000768 |
| Provider Name | Jacqueline M Becker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346261054 PECOS PAC ID: 6002871712 Enrollment ID: I20041122001018 |
| Provider Name | Carl Beckler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598785628 PECOS PAC ID: 6800859232 Enrollment ID: I20041122001095 |
| Provider Name | Hans Peter Diercksen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518984541 PECOS PAC ID: 7416912720 Enrollment ID: I20041129000668 |
| Provider Name | Indra Lovko |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912024076 PECOS PAC ID: 9537106992 Enrollment ID: I20050418000086 |
| Provider Name | John F Dick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073533048 PECOS PAC ID: 5991745416 Enrollment ID: I20050504000602 |
| Provider Name | Laura M Cohen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851315899 PECOS PAC ID: 8729029723 Enrollment ID: I20050519000988 |
| Provider Name | Sarah K Dudley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265545602 PECOS PAC ID: 2860420262 Enrollment ID: I20050727000866 |
| Provider Name | Richard C Baker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063477099 PECOS PAC ID: 5890724645 Enrollment ID: I20050811000600 |
| Provider Name | Kim Kurak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023041431 PECOS PAC ID: 1951335264 Enrollment ID: I20050926000233 |
| Provider Name | Julie A Foster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215957295 PECOS PAC ID: 2062437791 Enrollment ID: I20051011000927 |
| Provider Name | David I Schneider |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1518082254 PECOS PAC ID: 3375551013 Enrollment ID: I20060322000559 |
| Provider Name | Judith Lynn Ellwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699728436 PECOS PAC ID: 7214930379 Enrollment ID: I20060810000537 |
| Provider Name | Neil Senior |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588698252 PECOS PAC ID: 0941203988 Enrollment ID: I20060814000137 |
| Provider Name | George Fjeld |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720074743 PECOS PAC ID: 4284527060 Enrollment ID: I20060927000088 |
| Provider Name | Stephen S Kornbluth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811948847 PECOS PAC ID: 4880786334 Enrollment ID: I20070828001010 |
| Provider Name | Chris R Cornelius |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790858637 PECOS PAC ID: 0345283891 Enrollment ID: I20080506000111 |
| Provider Name | David B Turner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1114010881 PECOS PAC ID: 0042292161 Enrollment ID: I20080922000109 |
| Provider Name | Jean P Morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235390113 PECOS PAC ID: 1355418716 Enrollment ID: I20080926000259 |
| Provider Name | Colleen Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821255860 PECOS PAC ID: 0547337040 Enrollment ID: I20081014000039 |
| Provider Name | Christine M Malcolm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790956738 PECOS PAC ID: 6800855750 Enrollment ID: I20081105000224 |
| Provider Name | Gordon G Gieg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346208915 PECOS PAC ID: 1052471679 Enrollment ID: I20081126000456 |
| Provider Name | Erica E Tamblini |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033361829 PECOS PAC ID: 1052472750 Enrollment ID: I20081212000091 |
| Provider Name | Scott Douglas Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760471460 PECOS PAC ID: 7911063623 Enrollment ID: I20090304000740 |
| Provider Name | Rebecca K Heflin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497981393 PECOS PAC ID: 5193850675 Enrollment ID: I20100323000499 |
| Provider Name | Christopher Stronczak |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134140130 PECOS PAC ID: 4587836622 Enrollment ID: I20111013000310 |
| Provider Name | Adelaide Salley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467776286 PECOS PAC ID: 7719145374 Enrollment ID: I20120228000740 |
| Provider Name | Stephen J Wood |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588781660 PECOS PAC ID: 1153581525 Enrollment ID: I20120321000574 |
| Provider Name | Laurie A Coombs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316059579 PECOS PAC ID: 9335390897 Enrollment ID: I20121108000578 |
| Provider Name | Andrew Raymond Morton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679706485 PECOS PAC ID: 4082865225 Enrollment ID: I20121115000303 |
| Provider Name | Mary Katherine Sheffield |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437173465 PECOS PAC ID: 5395792790 Enrollment ID: I20130114000326 |
| Provider Name | Laura G Ethier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346585247 PECOS PAC ID: 6507011210 Enrollment ID: I20130304000217 |
| Provider Name | Lilah R Woodard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447534839 PECOS PAC ID: 4385810100 Enrollment ID: I20130712000203 |
| Provider Name | Annelise Ulrich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114250883 PECOS PAC ID: 2769622745 Enrollment ID: I20130716000416 |
| Provider Name | Megan I Greenleaf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730321514 PECOS PAC ID: 2365606985 Enrollment ID: I20130927000295 |
| Provider Name | Cristin A Craft |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578989240 PECOS PAC ID: 0345472429 Enrollment ID: I20140404000761 |
| Provider Name | Michelle A Wade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437587268 PECOS PAC ID: 2860624699 Enrollment ID: I20140410000345 |
| Provider Name | Jill V Read |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093735094 PECOS PAC ID: 7719104595 Enrollment ID: I20140819001888 |
| Provider Name | Theresa C. Haywood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891196804 PECOS PAC ID: 6507087905 Enrollment ID: I20141029000429 |
| Provider Name | Eleanor T Grabach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740282276 PECOS PAC ID: 4284947409 Enrollment ID: I20150717000029 |
| Provider Name | Sara J Locke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629442926 PECOS PAC ID: 6608172580 Enrollment ID: I20160303000980 |
| Provider Name | Kermit Brion Brunelle |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477529006 PECOS PAC ID: 3476872763 Enrollment ID: I20160321000543 |
| Provider Name | Diana Leah Ricitelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790014884 PECOS PAC ID: 4789715756 Enrollment ID: I20160324000997 |
| Provider Name | Jayme Hughes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396115648 PECOS PAC ID: 0749588630 Enrollment ID: I20160408001332 |
| Provider Name | Anna C Mccloy |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1386878148 PECOS PAC ID: 3476845017 Enrollment ID: I20160630000606 |
| Provider Name | Allison Adams |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1801096771 PECOS PAC ID: 5799077160 Enrollment ID: I20160705000755 |
| Provider Name | Elizabeth Richard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831524230 PECOS PAC ID: 1052534237 Enrollment ID: I20171207001115 |
| Provider Name | Laura K Lober |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962809053 PECOS PAC ID: 4082938774 Enrollment ID: I20180307000702 |
| Provider Name | Clare Conner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578943916 PECOS PAC ID: 4789994898 Enrollment ID: I20180405002282 |
| Provider Name | Kathryn Richards-peelle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427576941 PECOS PAC ID: 7719241579 Enrollment ID: I20180502000139 |
| Provider Name | Lisa Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992219471 PECOS PAC ID: 0749544260 Enrollment ID: I20180510000234 |
| Provider Name | Gary L. Gillen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851397236 PECOS PAC ID: 5193619799 Enrollment ID: I20181004001512 |
| Provider Name | Ayla L Carr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699141259 PECOS PAC ID: 9931409018 Enrollment ID: I20181101002118 |
| Provider Name | Richard M Orlan |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1700854379 PECOS PAC ID: 3375620297 Enrollment ID: I20181114000166 |
| Provider Name | Ali Kenyon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760900781 PECOS PAC ID: 3577818483 Enrollment ID: I20181205002438 |
| Provider Name | Jason Keicher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245329838 PECOS PAC ID: 6103187265 Enrollment ID: I20190401000740 |
| Provider Name | Kayla N Webster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801357603 PECOS PAC ID: 3274875414 Enrollment ID: I20190508001957 |
| Provider Name | Yohanny Giselle Santana |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316209687 PECOS PAC ID: 4789927203 Enrollment ID: I20190523001303 |
| Provider Name | Danielle M Robillard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346703360 PECOS PAC ID: 7618206285 Enrollment ID: I20190906001046 |
| Provider Name | Jennifer D Hanson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295878023 PECOS PAC ID: 9638465917 Enrollment ID: I20190909002590 |
| Provider Name | Amy Pfenning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295246379 PECOS PAC ID: 6800126202 Enrollment ID: I20190927001737 |
| Provider Name | Lisa Joan Graves-austin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508804634 PECOS PAC ID: 5395721419 Enrollment ID: I20190930002082 |
| Provider Name | Sally J Beayon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124672340 PECOS PAC ID: 3870824998 Enrollment ID: I20191003002431 |
| Provider Name | Jean Cynthia Letts |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174516256 PECOS PAC ID: 7719082775 Enrollment ID: I20191015000309 |
| Provider Name | Anne Wassell Hopkinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497062897 PECOS PAC ID: 7719319870 Enrollment ID: I20191112002284 |
| Provider Name | Ashley Rick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093180689 PECOS PAC ID: 3678905106 Enrollment ID: I20191121000503 |
| Provider Name | Cindy M Mcdonough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447289533 PECOS PAC ID: 9830126523 Enrollment ID: I20200609001351 |
| Provider Name | Krystal Judith Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093323750 PECOS PAC ID: 1254750367 Enrollment ID: I20200923000656 |
| Provider Name | Kaitlin R. Remington Van Hoesen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346506243 PECOS PAC ID: 8022438712 Enrollment ID: I20201019002098 |
| Provider Name | Alyssa Mazzariello |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215418363 PECOS PAC ID: 3072924232 Enrollment ID: I20201119003070 |
| Provider Name | Karyn H Farevaag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215364062 PECOS PAC ID: 9032336490 Enrollment ID: I20210224000423 |
| Provider Name | Barbara L Steinbrecher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699731414 PECOS PAC ID: 8224000377 Enrollment ID: I20210305000296 |
| Provider Name | Folake Azeez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508497280 PECOS PAC ID: 6507272994 Enrollment ID: I20210310000316 |
| Provider Name | Terri Redmond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699117630 PECOS PAC ID: 8527202035 Enrollment ID: I20210311002606 |
| Provider Name | Amanda K Domingus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881209328 PECOS PAC ID: 1355759267 Enrollment ID: I20210414000620 |
| Provider Name | Abigail Wikoff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831565597 PECOS PAC ID: 2668780404 Enrollment ID: I20210701002525 |
| Provider Name | Chelsea E Greeno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689241820 PECOS PAC ID: 0547662611 Enrollment ID: I20210712003218 |
| Provider Name | Daniel Lamar Sizemore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952763815 PECOS PAC ID: 2769761865 Enrollment ID: I20210920001973 |
| Provider Name | Michael Edward Lawrie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184392961 PECOS PAC ID: 7214334507 Enrollment ID: I20210929002617 |
| Provider Name | Paula Gagnon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558773705 PECOS PAC ID: 4385860519 Enrollment ID: I20211119000396 |
| Provider Name | Jacqueline M Eddy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114570371 PECOS PAC ID: 3375932841 Enrollment ID: I20211123001007 |
| Provider Name | Lewis L Monroe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336584812 PECOS PAC ID: 4789969171 Enrollment ID: I20220216000489 |
| Provider Name | Alexandra Welych-miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235881418 PECOS PAC ID: 3072906072 Enrollment ID: I20220216000852 |
| Provider Name | Kristen Casella |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396297594 PECOS PAC ID: 3971997685 Enrollment ID: I20220223000844 |
| Provider Name | Lisa Hartman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376299859 PECOS PAC ID: 3072909001 Enrollment ID: I20220331000474 |
| Provider Name | Melissa Mckibben |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851622070 PECOS PAC ID: 1254598139 Enrollment ID: I20220415001190 |
| Provider Name | Kellie Dahlstrom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972960888 PECOS PAC ID: 4082001854 Enrollment ID: I20220426000062 |
| Provider Name | Kathleen Huestis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255595641 PECOS PAC ID: 0143418871 Enrollment ID: I20220520001724 |
| Provider Name | Kayja Marie Champine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669136420 PECOS PAC ID: 1951780402 Enrollment ID: I20220614001295 |
| Provider Name | Jeffrey Craig Mazique |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902905300 PECOS PAC ID: 5193893279 Enrollment ID: I20220719002042 |
| Provider Name | Donald L Bloodworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679219752 PECOS PAC ID: 1355723396 Enrollment ID: I20220808000691 |
| Provider Name | Stephen Knox |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255439345 PECOS PAC ID: 0345424958 Enrollment ID: I20220823002428 |
| Provider Name | Nicole Reda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306452768 PECOS PAC ID: 4789093246 Enrollment ID: I20220921000174 |
| Provider Name | Stafford Eli Brannon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598486847 PECOS PAC ID: 8224404819 Enrollment ID: I20221024000735 |
| Provider Name | Maria Grace Durkee |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1386361194 PECOS PAC ID: 1658749981 Enrollment ID: I20221117002263 |
| Provider Name | Arthur Bellott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396842803 PECOS PAC ID: 4183804149 Enrollment ID: I20230222001574 |
| Provider Name | Job P Larson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326426651 PECOS PAC ID: 2860777232 Enrollment ID: I20230314001013 |
| Provider Name | Erin Joiner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144862871 PECOS PAC ID: 3870967326 Enrollment ID: I20230323001320 |
| Provider Name | Eva Mayer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1962573410 PECOS PAC ID: 6800865643 Enrollment ID: I20230328001084 |
| Provider Name | Sarah Hart Dwyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003511130 PECOS PAC ID: 4981079522 Enrollment ID: I20230412001410 |
| Provider Name | Jessica Cierea Price |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104362052 PECOS PAC ID: 9931483054 Enrollment ID: I20230615001515 |
| Provider Name | Jessica Zimmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285088146 PECOS PAC ID: 3779872098 Enrollment ID: I20230726001650 |
| Provider Name | Rebecca Merrifox |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1295362077 PECOS PAC ID: 5890116800 Enrollment ID: I20230803003016 |
| Provider Name | Michael Markowitz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033142922 PECOS PAC ID: 0840230934 Enrollment ID: I20230821000946 |
| Provider Name | Isobel Gabel Nimtz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093598351 PECOS PAC ID: 7719331883 Enrollment ID: I20230922000961 |
| Provider Name | Rebecca Edwards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659925089 PECOS PAC ID: 1254660715 Enrollment ID: I20231116002865 |
| Provider Name | Kaitlyn Ann Gawet-karpak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285409268 PECOS PAC ID: 1456709492 Enrollment ID: I20231130002812 |
| Provider Name | Jefferson Livermon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861462657 PECOS PAC ID: 4486787165 Enrollment ID: I20231222000056 |
| Provider Name | Rebecca C Hunke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891122883 PECOS PAC ID: 4183075989 Enrollment ID: I20240105001729 |
| Provider Name | Michele Pilz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518512193 PECOS PAC ID: 4789053596 Enrollment ID: I20240125000193 |
| Provider Name | Laurel Reed-becksted |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518743756 PECOS PAC ID: 5698127157 Enrollment ID: I20240207001802 |