| Tidelands Georgetown Memorial Hospital | |
|
606 Black River Rd Georgetown SC 29440-3304 | |
| (843) 527-7000 | |
| Not Available |
| Full Name | Tidelands Georgetown Memorial Hospital |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 606 Black River Rd, Georgetown, South Carolina |
| Authorized Official Name and Position | Erin Beadle (EVP & CFO) |
| Authorized Official Contact | 8435208617 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidelands Georgetown Memorial Hospital Po Box 421718 Georgetown SC 29442-4203 Ph: (843) 527-7142 | Tidelands Georgetown Memorial Hospital 606 Black River Rd Georgetown SC 29440-3304 Ph: (843) 527-7000 |
| NPI Number | 1982604021 |
|---|---|
| Provider Enumeration Date | 07/29/2005 |
| Last Update Date | 04/09/2026 |
| Certification Date | 04/09/2026 |
| Medicare PECOS PAC ID | 8224942123 |
|---|---|
| Medicare Enrollment ID | O20031114000600 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982604021 | NPI | - | NPPES |
| 343274 | Medicaid | SC | |
| 307128 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Secondary |
| 282N00000X | General Acute Care Hospital | HTL-0007 (South Carolina) | Primary |
| Provider Name | Matthew C Wallen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962442921 PECOS PAC ID: 8921911694 Enrollment ID: I20031110000038 |
| Provider Name | George Albert Wilkinson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790787406 PECOS PAC ID: 4587568969 Enrollment ID: I20031126000412 |
| Provider Name | James D Givens |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1750398525 PECOS PAC ID: 2062307754 Enrollment ID: I20040220000505 |
| Provider Name | Morgan a Lowry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194791087 PECOS PAC ID: 9537054572 Enrollment ID: I20040220000733 |
| Provider Name | Stephen Joseph O Connor |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134137623 PECOS PAC ID: 3678564242 Enrollment ID: I20040521000600 |
| Provider Name | Christopher George Pelic |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396853263 PECOS PAC ID: 7911982152 Enrollment ID: I20040622000270 |
| Provider Name | Jill Aiken |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1376597666 PECOS PAC ID: 4385611425 Enrollment ID: I20040916000751 |
| Provider Name | David K Haseltine |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396747820 PECOS PAC ID: 5799752861 Enrollment ID: I20040916001011 |
| Provider Name | Cassandra D Salgado |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912015876 PECOS PAC ID: 7214905082 Enrollment ID: I20040920000681 |
| Provider Name | Lucretia Ann Carter |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881642817 PECOS PAC ID: 7618939588 Enrollment ID: I20041102001000 |
| Provider Name | Carol Ann Bogdan |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1033102538 PECOS PAC ID: 6608831979 Enrollment ID: I20041129000380 |
| Provider Name | Matthew J Desalvo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942206826 PECOS PAC ID: 8729045604 Enrollment ID: I20041213000281 |
| Provider Name | Stephanie Woollen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790780096 PECOS PAC ID: 0345231932 Enrollment ID: I20050106000267 |
| Provider Name | Jonathan J Halford |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346284726 PECOS PAC ID: 9739139312 Enrollment ID: I20050201000205 |
| Provider Name | Joseph R Cantey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073621926 PECOS PAC ID: 6305898412 Enrollment ID: I20050217000228 |
| Provider Name | Christopher D Nielsen |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1477661429 PECOS PAC ID: 7618944141 Enrollment ID: I20050308000277 |
| Provider Name | Valerian L Fernandes |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1912015967 PECOS PAC ID: 2769436252 Enrollment ID: I20050308000760 |
| Provider Name | Amy Sprague |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629030598 PECOS PAC ID: 6204882673 Enrollment ID: I20050329000661 |
| Provider Name | Terrence E Steyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730297698 PECOS PAC ID: 2668408238 Enrollment ID: I20050714000665 |
| Provider Name | Richard Carlton Cutchin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629021829 PECOS PAC ID: 3577545094 Enrollment ID: I20050912000536 |
| Provider Name | Ekong Ito Eta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598945081 PECOS PAC ID: 6800821026 Enrollment ID: I20050927000842 |
| Provider Name | Scott a Coradi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932101821 PECOS PAC ID: 3375568108 Enrollment ID: I20051011000887 |
| Provider Name | Dana P Giarrizzi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497784680 PECOS PAC ID: 5395770044 Enrollment ID: I20051019000345 |
| Provider Name | Melissa R Bliss |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1326005695 PECOS PAC ID: 6709805740 Enrollment ID: I20051118000138 |
| Provider Name | Joseph Ratliffe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083659874 PECOS PAC ID: 5698785814 Enrollment ID: I20060719000259 |
| Provider Name | Amanda Battisti |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760415749 PECOS PAC ID: 4688668973 Enrollment ID: I20060801000381 |
| Provider Name | Peter J Zavell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154327229 PECOS PAC ID: 5092713750 Enrollment ID: I20061114000147 |
| Provider Name | Sara Adams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043397391 PECOS PAC ID: 7315044328 Enrollment ID: I20070525000001 |
| Provider Name | Ted D Burrow |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346203148 PECOS PAC ID: 7113974015 Enrollment ID: I20070730000417 |
| Provider Name | James M Principe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720080278 PECOS PAC ID: 4385618586 Enrollment ID: I20070730000486 |
| Provider Name | Christopher C Ezeihuaku |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275672099 PECOS PAC ID: 2567553894 Enrollment ID: I20070801000175 |
| Provider Name | Jonathan C Edwards |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619066586 PECOS PAC ID: 7315038379 Enrollment ID: I20070806000098 |
| Provider Name | Fredric Carroll Woriax |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326127523 PECOS PAC ID: 1850486945 Enrollment ID: I20071004000318 |
| Provider Name | Emmanuel Awuku Yirenkyi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1326264425 PECOS PAC ID: 2466547575 Enrollment ID: I20071004000567 |
| Provider Name | Fady S Grace |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669679007 PECOS PAC ID: 4587750807 Enrollment ID: I20071018000273 |
| Provider Name | Dante Lewis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508843442 PECOS PAC ID: 0143310144 Enrollment ID: I20071214000014 |
| Provider Name | Michael J Ratz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922121136 PECOS PAC ID: 5991880783 Enrollment ID: I20080304000215 |
| Provider Name | Faron J Kemp |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558363093 PECOS PAC ID: 7113005091 Enrollment ID: I20080417000141 |
| Provider Name | Daniel Steinberg |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1134394398 PECOS PAC ID: 4981777091 Enrollment ID: I20080723000461 |
| Provider Name | Evelyn M Parish |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962573386 PECOS PAC ID: 1355399627 Enrollment ID: I20080723000743 |
| Provider Name | Michael L Masiowski |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639217821 PECOS PAC ID: 0143394536 Enrollment ID: I20080804000000 |
| Provider Name | William Whiteside |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1780694588 PECOS PAC ID: 6002981743 Enrollment ID: I20080815000039 |
| Provider Name | David Lee Milling |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1184712093 PECOS PAC ID: 0345315438 Enrollment ID: I20080825000624 |
| Provider Name | William Mccall Goldstein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336287523 PECOS PAC ID: 1951477793 Enrollment ID: I20080903000035 |
| Provider Name | Ariane U Lieberman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548262124 PECOS PAC ID: 1355418393 Enrollment ID: I20080917000547 |
| Provider Name | Angela C Sheridan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043460215 PECOS PAC ID: 8820156904 Enrollment ID: I20081017000454 |
| Provider Name | Lamberto S Paragas |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194727057 PECOS PAC ID: 1951461953 Enrollment ID: I20081120000618 |
| Provider Name | Gretchen Anne Meyer |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1376598227 PECOS PAC ID: 8628089877 Enrollment ID: I20090121000371 |
| Provider Name | Dominic a Offiong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497730097 PECOS PAC ID: 3274553649 Enrollment ID: I20090212000434 |
| Provider Name | Gerald E Harmon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821073321 PECOS PAC ID: 9537226220 Enrollment ID: I20090325000095 |
| Provider Name | Felix E Kuuseg |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871732347 PECOS PAC ID: 6305997339 Enrollment ID: I20090702000019 |
| Provider Name | Ahmad T Haq |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710082425 PECOS PAC ID: 3072407451 Enrollment ID: I20090731000477 |
| Provider Name | Robert Dorlon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144261355 PECOS PAC ID: 0840380614 Enrollment ID: I20091027000104 |
| Provider Name | Victor Sidhom |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891989075 PECOS PAC ID: 5698869832 Enrollment ID: I20091120000003 |
| Provider Name | Tamara Noel Bowman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194059360 PECOS PAC ID: 6901945021 Enrollment ID: I20091203000307 |
| Provider Name | John K Ijem |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1457353138 PECOS PAC ID: 3577603612 Enrollment ID: I20091221000408 |
| Provider Name | Victor Manuel Diaz-gonzalez |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1952303620 PECOS PAC ID: 7911047063 Enrollment ID: I20091221000439 |
| Provider Name | Nicole Franklin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629275540 PECOS PAC ID: 5991832578 Enrollment ID: I20100430000336 |
| Provider Name | Larry Wade Kelly |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1194727628 PECOS PAC ID: 4981788791 Enrollment ID: I20100611000197 |
| Provider Name | Mark Overton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568437184 PECOS PAC ID: 1153451141 Enrollment ID: I20100618000118 |
| Provider Name | Scott Andrew Nicol |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902808447 PECOS PAC ID: 2264517457 Enrollment ID: I20100713000407 |
| Provider Name | Thomas M Todoran |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1104945955 PECOS PAC ID: 8729112271 Enrollment ID: I20100819000012 |
| Provider Name | Victoria Elizabeth Moshoures |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306845755 PECOS PAC ID: 3779643770 Enrollment ID: I20100819000331 |
| Provider Name | John C Lewis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881744555 PECOS PAC ID: 8527184720 Enrollment ID: I20100924000924 |
| Provider Name | Emad Sabry Shafiek Grace |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790989499 PECOS PAC ID: 1658435987 Enrollment ID: I20101206000080 |
| Provider Name | Justin M Garzone |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770806804 PECOS PAC ID: 6608063235 Enrollment ID: I20101208001279 |
| Provider Name | Ekrem Kutluay |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1083661920 PECOS PAC ID: 8426145558 Enrollment ID: I20110121000737 |
| Provider Name | Evgenia Kagan |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1578759502 PECOS PAC ID: 4486737566 Enrollment ID: I20110413000191 |
| Provider Name | Rami Samir Zaki |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1740489111 PECOS PAC ID: 8628164902 Enrollment ID: I20110516000604 |
| Provider Name | Jeffrey M Aversa |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1992850887 PECOS PAC ID: 4082602644 Enrollment ID: I20110719000236 |
| Provider Name | Anbukarasi Maran |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1861579112 PECOS PAC ID: 8325218076 Enrollment ID: I20110907001098 |
| Provider Name | Mary E Ross |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346446499 PECOS PAC ID: 5395916639 Enrollment ID: I20110919000430 |
| Provider Name | Shannon M Marcotte |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174721880 PECOS PAC ID: 4385799972 Enrollment ID: I20111026000814 |
| Provider Name | John J Manning |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619979192 PECOS PAC ID: 7214102847 Enrollment ID: I20111209000687 |
| Provider Name | John M Stover |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942202411 PECOS PAC ID: 0749296291 Enrollment ID: I20111209000771 |
| Provider Name | Eugene V Mayeaux |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780685966 PECOS PAC ID: 5890960439 Enrollment ID: I20111209000778 |
| Provider Name | Joseph J Gammel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982606646 PECOS PAC ID: 9335314970 Enrollment ID: I20111209000782 |
| Provider Name | Jackson Mccrea Ewart |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1699955005 PECOS PAC ID: 0345324554 Enrollment ID: I20111220000601 |
| Provider Name | Jamie D Kandora |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1952679524 PECOS PAC ID: 7315114212 Enrollment ID: I20120118000002 |
| Provider Name | William D Richmond |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457343782 PECOS PAC ID: 5799952164 Enrollment ID: I20120126000001 |
| Provider Name | Anne Marie Bridegroom |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1811262694 PECOS PAC ID: 1052574902 Enrollment ID: I20120514000219 |
| Provider Name | Leonardo Bonilha |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1861699969 PECOS PAC ID: 6901053107 Enrollment ID: I20120822000821 |
| Provider Name | John F D Alessandro |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1396877338 PECOS PAC ID: 3375619802 Enrollment ID: I20130219000570 |
| Provider Name | John W Gnann |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467498659 PECOS PAC ID: 0143415786 Enrollment ID: I20130327000529 |
| Provider Name | Bushra Abid |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1659534469 PECOS PAC ID: 8527206333 Enrollment ID: I20130605000562 |
| Provider Name | Stephanie J Hightower |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629261342 PECOS PAC ID: 3274617444 Enrollment ID: I20130830000777 |
| Provider Name | Mahmood Shahab Sori |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558662700 PECOS PAC ID: 8123254836 Enrollment ID: I20131127001725 |
| Provider Name | Christopher H Register |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053308981 PECOS PAC ID: 9436049525 Enrollment ID: I20131204000307 |
| Provider Name | Amanda B Belesky |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578908950 PECOS PAC ID: 0749424877 Enrollment ID: I20131210001358 |
| Provider Name | Allyson Rae Bender |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588903397 PECOS PAC ID: 3375771587 Enrollment ID: I20140115001671 |
| Provider Name | Charles O Duncan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033413547 PECOS PAC ID: 6901036920 Enrollment ID: I20140312001908 |
| Provider Name | Jay T Johnson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265626006 PECOS PAC ID: 8325108822 Enrollment ID: I20140428000349 |
| Provider Name | Richard Andrew Philipp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144668930 PECOS PAC ID: 3971728387 Enrollment ID: I20140626002592 |
| Provider Name | Steven Christopher Baird |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710255732 PECOS PAC ID: 4880834977 Enrollment ID: I20140814000325 |
| Provider Name | Mikhail Vinogradov |
|---|---|
| Provider Type | Practitioner - Hematology |
| Provider Identifiers | NPI Number: 1073518452 PECOS PAC ID: 7911979497 Enrollment ID: I20140818002161 |
| Provider Name | Catherine Baker Burbage |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1639358310 PECOS PAC ID: 6507021730 Enrollment ID: I20140826002839 |
| Provider Name | Amangeldi Rahmanov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275829004 PECOS PAC ID: 8224256490 Enrollment ID: I20140829001402 |
| Provider Name | Nazrul Islam Chowdhury |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1124345830 PECOS PAC ID: 8628204450 Enrollment ID: I20140905002198 |
| Provider Name | Christopher Darin Mann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043281256 PECOS PAC ID: 4789632621 Enrollment ID: I20140922000004 |
| Provider Name | Lena S Sandifer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164746962 PECOS PAC ID: 0244459386 Enrollment ID: I20140922002454 |
| Provider Name | Lananh Nguyen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790070415 PECOS PAC ID: 2668637190 Enrollment ID: I20140925002160 |
| Provider Name | Marlo Denise Bruno |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861787152 PECOS PAC ID: 5991921207 Enrollment ID: I20141008000267 |
| Provider Name | Matilda Serwaa Malm |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649582032 PECOS PAC ID: 2163665571 Enrollment ID: I20141014001711 |
| Provider Name | Ryan Mackenzie Connor |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1205274693 PECOS PAC ID: 8820219363 Enrollment ID: I20141024002143 |
| Provider Name | Mary S Baker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134431935 PECOS PAC ID: 3779705231 Enrollment ID: I20141118000683 |
| Provider Name | Bryan Wayne Howington |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1184062416 PECOS PAC ID: 8426370008 Enrollment ID: I20141210001224 |
| Provider Name | Megan Mcleod Dodson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1750720850 PECOS PAC ID: 8022333111 Enrollment ID: I20150212000926 |
| Provider Name | William M Brown |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1538237383 PECOS PAC ID: 0648457309 Enrollment ID: I20150310001221 |
| Provider Name | Bryan Bradford Gibson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144517798 PECOS PAC ID: 6204067911 Enrollment ID: I20150420001409 |
| Provider Name | Brian Joseph Griggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265697734 PECOS PAC ID: 4385615822 Enrollment ID: I20150428000573 |
| Provider Name | Solomon a Jan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457538316 PECOS PAC ID: 0547344087 Enrollment ID: I20150428001984 |
| Provider Name | Nancy M Campbell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1134155054 PECOS PAC ID: 1153217724 Enrollment ID: I20150507001134 |
| Provider Name | Carol S Eaton |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881846947 PECOS PAC ID: 2365504388 Enrollment ID: I20150730013079 |
| Provider Name | Sarah Elizabeth Schmitt |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1437214681 PECOS PAC ID: 3577648179 Enrollment ID: I20150930003225 |
| Provider Name | David J Steflik |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1528355724 PECOS PAC ID: 3971724956 Enrollment ID: I20151207000497 |
| Provider Name | Fidelis Okotie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376856039 PECOS PAC ID: 0547384794 Enrollment ID: I20160428001402 |
| Provider Name | Christina R Hardwick |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1902818495 PECOS PAC ID: 5890823058 Enrollment ID: I20160512000255 |
| Provider Name | Robert a Craven |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518132257 PECOS PAC ID: 6204007669 Enrollment ID: I20160526002569 |
| Provider Name | William a Meeks |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1477993392 PECOS PAC ID: 2567755374 Enrollment ID: I20160801000697 |
| Provider Name | Ashley Marie Wabnitz |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1649563214 PECOS PAC ID: 0042528044 Enrollment ID: I20161010001657 |
| Provider Name | Hsiao L Soriano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366737132 PECOS PAC ID: 3173740529 Enrollment ID: I20161014001866 |
| Provider Name | Saint Julien Springs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063825230 PECOS PAC ID: 4981928207 Enrollment ID: I20161109002364 |
| Provider Name | Jeffrey Peter Yourshaw |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1003109869 PECOS PAC ID: 5890912869 Enrollment ID: I20161110000348 |
| Provider Name | Christopher Tran Bach |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1821313057 PECOS PAC ID: 4789834276 Enrollment ID: I20161116000013 |
| Provider Name | Brintha F Vasagar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780926188 PECOS PAC ID: 5991939613 Enrollment ID: I20161222000498 |
| Provider Name | Catherine a Gillespie |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629055009 PECOS PAC ID: 0244127918 Enrollment ID: I20170517000976 |
| Provider Name | Susangeline Schmidt Strickland |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336340751 PECOS PAC ID: 5294888046 Enrollment ID: I20170613001245 |
| Provider Name | Linda Lewallen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437224201 PECOS PAC ID: 3274626023 Enrollment ID: I20170706001898 |
| Provider Name | Andrew Bryant Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265968770 PECOS PAC ID: 8123399482 Enrollment ID: I20170803003830 |
| Provider Name | Brandon J Stransky |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710229273 PECOS PAC ID: 0244545085 Enrollment ID: I20170810001546 |
| Provider Name | Amy J Bach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598046971 PECOS PAC ID: 5799957510 Enrollment ID: I20170817002934 |
| Provider Name | Deborah Cintron |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821195892 PECOS PAC ID: 6507833753 Enrollment ID: I20170823003015 |
| Provider Name | Anish Atulkumar Brahmbhatt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437579778 PECOS PAC ID: 5395063127 Enrollment ID: I20171006001105 |
| Provider Name | Heather Nicole Maffeo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1568903391 PECOS PAC ID: 0244505717 Enrollment ID: I20171010000062 |
| Provider Name | Ryan J Galica |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1275891749 PECOS PAC ID: 3971879560 Enrollment ID: I20171026001531 |
| Provider Name | Pauline Seebode |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518489814 PECOS PAC ID: 3072889385 Enrollment ID: I20171031002215 |
| Provider Name | Nkiruka Nnebe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982667069 PECOS PAC ID: 3577597285 Enrollment ID: I20171108002343 |
| Provider Name | Timothy S. Ryan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376982470 PECOS PAC ID: 5799001905 Enrollment ID: I20171218001532 |
| Provider Name | Paul Abrams |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1619264280 PECOS PAC ID: 8729238381 Enrollment ID: I20180112000011 |
| Provider Name | Maureen a Tumolo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1891963286 PECOS PAC ID: 4385814235 Enrollment ID: I20180508001033 |
| Provider Name | Curtis Jamison |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598055790 PECOS PAC ID: 6103041603 Enrollment ID: I20180613001170 |
| Provider Name | Heidi J Steflik |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659660496 PECOS PAC ID: 6608177563 Enrollment ID: I20180713001584 |
| Provider Name | Alexei M Zhadkevich |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760642268 PECOS PAC ID: 5698078533 Enrollment ID: I20180716000364 |
| Provider Name | Adam Christopher Hughes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083096192 PECOS PAC ID: 8426354457 Enrollment ID: I20180716002408 |
| Provider Name | Nicholas Stephen Amoroso |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1326366378 PECOS PAC ID: 3870885676 Enrollment ID: I20180726002188 |
| Provider Name | Elizabeth Genovese |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1609162999 PECOS PAC ID: 8921304130 Enrollment ID: I20180727001018 |
| Provider Name | Jonathan D Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447657622 PECOS PAC ID: 6507115599 Enrollment ID: I20180824000616 |
| Provider Name | Michael C Malinics |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1255499653 PECOS PAC ID: 4082526199 Enrollment ID: I20180829001911 |
| Provider Name | Aalap Shah |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356760078 PECOS PAC ID: 8921228727 Enrollment ID: I20180829002289 |
| Provider Name | Neal P Johnson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710365788 PECOS PAC ID: 8022382209 Enrollment ID: I20180918000758 |
| Provider Name | Carolyn a Hans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528419322 PECOS PAC ID: 5193007243 Enrollment ID: I20180919000672 |
| Provider Name | Faisal Majeed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225411838 PECOS PAC ID: 7113218124 Enrollment ID: I20180926004195 |
| Provider Name | Abhinav Goyal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366756447 PECOS PAC ID: 7214174325 Enrollment ID: I20181115003039 |
| Provider Name | Liliana Banari |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1700143344 PECOS PAC ID: 0547504235 Enrollment ID: I20181206002576 |
| Provider Name | Ann O Idemundia-bryant |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1235233545 PECOS PAC ID: 2860468071 Enrollment ID: I20181210003016 |
| Provider Name | Isaac Ikwu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780017988 PECOS PAC ID: 0749503266 Enrollment ID: I20181211002180 |
| Provider Name | Christina F Tolbert |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417396219 PECOS PAC ID: 7214256171 Enrollment ID: I20181221000001 |
| Provider Name | Danuel Keith Snelgrove |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396159489 PECOS PAC ID: 9537483052 Enrollment ID: I20190107002453 |
| Provider Name | Tammy Susan Alverson |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1760558092 PECOS PAC ID: 2860673969 Enrollment ID: I20190123004174 |
| Provider Name | Kaleigh Elizabeth Seals |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831659770 PECOS PAC ID: 7810230497 Enrollment ID: I20190522002507 |
| Provider Name | John B Latimer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134180912 PECOS PAC ID: 3779517982 Enrollment ID: I20190718001785 |
| Provider Name | Cathy R Xu |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609078831 PECOS PAC ID: 7012192305 Enrollment ID: I20190805001950 |
| Provider Name | Lauren Victoria Jackson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639524945 PECOS PAC ID: 8426347006 Enrollment ID: I20190814002563 |
| Provider Name | Sonia Suda |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1104210459 PECOS PAC ID: 3678878808 Enrollment ID: I20190910002473 |
| Provider Name | Paul Wolfe |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1669410411 PECOS PAC ID: 4082605662 Enrollment ID: I20191009001208 |
| Provider Name | Eskinder Nesrane |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528415775 PECOS PAC ID: 6709219173 Enrollment ID: I20191126001846 |
| Provider Name | Mary Catherine Chrabaszcz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154724839 PECOS PAC ID: 5799008744 Enrollment ID: I20191226002114 |
| Provider Name | Johanna Delacroix |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689807315 PECOS PAC ID: 7214238856 Enrollment ID: I20200324003853 |
| Provider Name | Hisham Ibrahim Bassiouni |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1205883105 PECOS PAC ID: 0244248771 Enrollment ID: I20200330002388 |
| Provider Name | Michael Edward Raymo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700341161 PECOS PAC ID: 3375885197 Enrollment ID: I20200402002680 |
| Provider Name | Motaz Baibars |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104121193 PECOS PAC ID: 7315105814 Enrollment ID: I20200415001398 |
| Provider Name | Daniel C Michalski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841830940 PECOS PAC ID: 2466882022 Enrollment ID: I20200422000764 |
| Provider Name | Michael Patrick Stribos |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588191134 PECOS PAC ID: 0042631319 Enrollment ID: I20200522001957 |
| Provider Name | Anna Catherine Catalano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508392440 PECOS PAC ID: 3072882414 Enrollment ID: I20200619001883 |
| Provider Name | Vasudha Jain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982131603 PECOS PAC ID: 2264706456 Enrollment ID: I20200709002157 |
| Provider Name | Sean H Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225568181 PECOS PAC ID: 0244504447 Enrollment ID: I20200710002403 |
| Provider Name | Steven Longacre |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417933516 PECOS PAC ID: 3678622404 Enrollment ID: I20200716000886 |
| Provider Name | Christine Laura Gamble |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396277042 PECOS PAC ID: 3274871389 Enrollment ID: I20200720002249 |
| Provider Name | Ahmad I Issa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689946212 PECOS PAC ID: 1557504677 Enrollment ID: I20200811000426 |
| Provider Name | Purav Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902338742 PECOS PAC ID: 7719224104 Enrollment ID: I20200903002307 |
| Provider Name | Henry Lau |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861432601 PECOS PAC ID: 2264435551 Enrollment ID: I20201013003627 |
| Provider Name | Manoj Gupta |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801895735 PECOS PAC ID: 9032013099 Enrollment ID: I20201019000861 |
| Provider Name | Carol M Reid |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1508974361 PECOS PAC ID: 1355477399 Enrollment ID: I20201030000274 |
| Provider Name | Mark O Owolabi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578945507 PECOS PAC ID: 3971851429 Enrollment ID: I20201125001126 |
| Provider Name | Deborah Ruth Mckee |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1992768907 PECOS PAC ID: 2062589435 Enrollment ID: I20210128000433 |
| Provider Name | Jeffrey Cronk |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1811956220 PECOS PAC ID: 4981673266 Enrollment ID: I20210302001849 |
| Provider Name | Wycliffe Okumu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689832354 PECOS PAC ID: 9335295310 Enrollment ID: I20210310002522 |
| Provider Name | Catherine Chatillon Bourne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164029104 PECOS PAC ID: 3274941612 Enrollment ID: I20210422003019 |
| Provider Name | Janet Marie Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023676681 PECOS PAC ID: 2567792237 Enrollment ID: I20210427002098 |
| Provider Name | Shaheryar Ali Jafri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033595830 PECOS PAC ID: 5597027649 Enrollment ID: I20210617000554 |
| Provider Name | Leon Rosen |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1477661437 PECOS PAC ID: 5799758603 Enrollment ID: I20210623002284 |
| Provider Name | Sarah Campos Monell |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1316010853 PECOS PAC ID: 6709921166 Enrollment ID: I20210630004104 |
| Provider Name | Nitesh J. Ainani |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1952718074 PECOS PAC ID: 3476770470 Enrollment ID: I20210713001899 |
| Provider Name | Danh Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407420607 PECOS PAC ID: 9133521867 Enrollment ID: I20210716001925 |
| Provider Name | Joanna Joy Ward |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1023682655 PECOS PAC ID: 2466855374 Enrollment ID: I20210729000238 |
| Provider Name | Colleen Marie Christiansen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083880850 PECOS PAC ID: 9739378746 Enrollment ID: I20210802001809 |
| Provider Name | Debra Mccauley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578094124 PECOS PAC ID: 5092087171 Enrollment ID: I20210804000456 |
| Provider Name | Jack M Johnston |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1033590054 PECOS PAC ID: 1951601210 Enrollment ID: I20210804000609 |
| Provider Name | Vinh Doan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265927792 PECOS PAC ID: 2668717349 Enrollment ID: I20210804001868 |
| Provider Name | Timothy Gaw |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679003321 PECOS PAC ID: 3870914450 Enrollment ID: I20210805001524 |
| Provider Name | Courtney Sturgill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275115354 PECOS PAC ID: 1052715208 Enrollment ID: I20210810001720 |
| Provider Name | Oluwaseun a Omofoye |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1215296223 PECOS PAC ID: 6608096151 Enrollment ID: I20210819001564 |
| Provider Name | Adam Tanious |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1508108994 PECOS PAC ID: 9931459013 Enrollment ID: I20210831002310 |
| Provider Name | Matthew Joel Mccoskey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992293450 PECOS PAC ID: 1951707280 Enrollment ID: I20210910002050 |
| Provider Name | Jacqueline Sennott |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1629411707 PECOS PAC ID: 3173744018 Enrollment ID: I20210913000602 |
| Provider Name | Benjamin W Greenwood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235615253 PECOS PAC ID: 5890191902 Enrollment ID: I20210914003065 |
| Provider Name | Scott Callaghan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497747018 PECOS PAC ID: 4385696582 Enrollment ID: I20210922000132 |
| Provider Name | Annacecilia Peacher Holderied |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1891053195 PECOS PAC ID: 6305180613 Enrollment ID: I20210923002012 |
| Provider Name | Matthew Edward Gibson |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1316386303 PECOS PAC ID: 3173745064 Enrollment ID: I20210924000179 |
| Provider Name | Jie Yu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730685025 PECOS PAC ID: 1052668894 Enrollment ID: I20210930000591 |
| Provider Name | Gabrielle Maybee |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1770566432 PECOS PAC ID: 9537341961 Enrollment ID: I20211014002367 |
| Provider Name | Robert Scott Milam |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1821267154 PECOS PAC ID: 6901931757 Enrollment ID: I20211021002213 |
| Provider Name | Sarah Carver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356913271 PECOS PAC ID: 8426447640 Enrollment ID: I20211109003529 |
| Provider Name | Marguerite Saith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497702534 PECOS PAC ID: 0244288546 Enrollment ID: I20211111000836 |
| Provider Name | Hope Justine Brinkmann |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1447827068 PECOS PAC ID: 8022407790 Enrollment ID: I20211118000861 |
| Provider Name | Christopher Alan Lane |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1225063647 PECOS PAC ID: 8729023171 Enrollment ID: I20211201002665 |
| Provider Name | Jo Anne S Klein |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1548465651 PECOS PAC ID: 8628129913 Enrollment ID: I20220125002674 |
| Provider Name | Sugabramya Kuru |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669962189 PECOS PAC ID: 6901208180 Enrollment ID: I20220208001943 |
| Provider Name | Jaime Garcia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659477362 PECOS PAC ID: 2365496601 Enrollment ID: I20220214000974 |
| Provider Name | Jarrett Burns |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659420404 PECOS PAC ID: 5395898316 Enrollment ID: I20220215000099 |
| Provider Name | Allison Devaux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326715343 PECOS PAC ID: 0446644074 Enrollment ID: I20220225000048 |
| Provider Name | Karen Meyer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1538141437 PECOS PAC ID: 7012988280 Enrollment ID: I20220228002425 |
| Provider Name | Mary Katherine Holland |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1245906452 PECOS PAC ID: 8820482854 Enrollment ID: I20220308001131 |
| Provider Name | Jan Marie Griffin |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1659632701 PECOS PAC ID: 1254551369 Enrollment ID: I20220407000116 |
| Provider Name | Bishnu P Dhakal |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1700070117 PECOS PAC ID: 9739213224 Enrollment ID: I20220718003792 |
| Provider Name | James E West |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1891794384 PECOS PAC ID: 4183663255 Enrollment ID: I20220801002119 |
| Provider Name | Timothy J Hoffman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710543236 PECOS PAC ID: 5597098525 Enrollment ID: I20220813000609 |
| Provider Name | Anderson Wang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225653314 PECOS PAC ID: 5799104436 Enrollment ID: I20220818003830 |
| Provider Name | Michael a Alvarado |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1750801841 PECOS PAC ID: 4385915610 Enrollment ID: I20220825003765 |
| Provider Name | Robin Nicole Lange |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568985133 PECOS PAC ID: 1658793831 Enrollment ID: I20220909001841 |
| Provider Name | Richard B Rhodes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679130496 PECOS PAC ID: 1759612120 Enrollment ID: I20220909002072 |
| Provider Name | Benjamin Ford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225699671 PECOS PAC ID: 0042545295 Enrollment ID: I20220912003073 |
| Provider Name | Rebecca Ann Townsend |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962502815 PECOS PAC ID: 0143111534 Enrollment ID: I20220923002785 |
| Provider Name | Dana Lev-ran |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417417270 PECOS PAC ID: 0840676094 Enrollment ID: I20220926002834 |
| Provider Name | Taylor Thrash |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871158121 PECOS PAC ID: 7012349053 Enrollment ID: I20221110000148 |
| Provider Name | Angela Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619200946 PECOS PAC ID: 0042358467 Enrollment ID: I20221221003223 |
| Provider Name | Abby Sapp |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1538400247 PECOS PAC ID: 5294023057 Enrollment ID: I20221228000695 |
| Provider Name | Andrew Nguyen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881258218 PECOS PAC ID: 1951635564 Enrollment ID: I20221230002501 |
| Provider Name | Elizabeth a Suniega |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902206907 PECOS PAC ID: 5193043362 Enrollment ID: I20230109002300 |
| Provider Name | Charmaine Eulette Belto-mills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124685573 PECOS PAC ID: 9931571825 Enrollment ID: I20230201002834 |
| Provider Name | Frank S Rosenbloom |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306924691 PECOS PAC ID: 9234288416 Enrollment ID: I20230207003048 |
| Provider Name | Sidney Coupet |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1285803262 PECOS PAC ID: 4688837214 Enrollment ID: I20230315000758 |
| Provider Name | Elizabeth Mary Chouinard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659903078 PECOS PAC ID: 9234594003 Enrollment ID: I20230501000394 |
| Provider Name | Taylor Harrison Polk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093343584 PECOS PAC ID: 4082074083 Enrollment ID: I20230724000624 |
| Provider Name | Daniel Cunningham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427308980 PECOS PAC ID: 9537478698 Enrollment ID: I20230726001750 |
| Provider Name | Joshua M Richmond |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477127397 PECOS PAC ID: 5092119446 Enrollment ID: I20230824001845 |
| Provider Name | Ming Yin |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1255630505 PECOS PAC ID: 4981976297 Enrollment ID: I20230922003542 |
| Provider Name | Tracey Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861941072 PECOS PAC ID: 1355623281 Enrollment ID: I20231013002602 |
| Provider Name | Adam Christian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255956561 PECOS PAC ID: 1850759150 Enrollment ID: I20231016003308 |
| Provider Name | Aubrey Westwood |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1063187540 PECOS PAC ID: 4587052790 Enrollment ID: I20231106002682 |
| Provider Name | Matthew Deysher |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861969669 PECOS PAC ID: 7719222090 Enrollment ID: I20240122000478 |
| Provider Name | Stephanie Louise Saridakis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1467924894 PECOS PAC ID: 0042559718 Enrollment ID: I20240221003110 |
| Provider Name | Tal Pollak |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1770831158 PECOS PAC ID: 9234370982 Enrollment ID: I20240226001532 |
| Provider Name | Teresa Herlevi |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1801172390 PECOS PAC ID: 1254591043 Enrollment ID: I20240312003293 |
| Provider Name | James a Durden |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699352310 PECOS PAC ID: 6507260940 Enrollment ID: I20240613004372 |
| Provider Name | Jonathan Boland |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669059127 PECOS PAC ID: 8527441740 Enrollment ID: I20240621002263 |
| Provider Name | Jack Thomas Sutcliffe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548849623 PECOS PAC ID: 9638554843 Enrollment ID: I20240717004919 |
| Provider Name | Catherine Izzo |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1215779970 PECOS PAC ID: 2466998018 Enrollment ID: I20240719001430 |
| Provider Name | Katie Newton Kennedy |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1104357698 PECOS PAC ID: 7214200120 Enrollment ID: I20240802003023 |
| Provider Name | Sue Del Carmen Cruz Gerena |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528644903 PECOS PAC ID: 1658773825 Enrollment ID: I20240807000723 |
| Provider Name | Marcus Lansing Oliver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790365716 PECOS PAC ID: 5991244808 Enrollment ID: I20240822004861 |
| Provider Name | Chloe Michelle Pullo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578128484 PECOS PAC ID: 5294069019 Enrollment ID: I20240925002772 |
| Provider Name | Jonathon Monroe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457937039 PECOS PAC ID: 9739582040 Enrollment ID: I20241001002715 |
| Provider Name | Elizabeth Weatherly Francis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366029050 PECOS PAC ID: 8325579022 Enrollment ID: I20241004003398 |
| Provider Name | Aaron Brophy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295409340 PECOS PAC ID: 7810429107 Enrollment ID: I20241010003889 |
| Provider Name | Joseph Alexander Chafardon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891374443 PECOS PAC ID: 9739611617 Enrollment ID: I20241016003358 |
| Provider Name | Shannon Michelle Colantuono |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1588136212 PECOS PAC ID: 5496092322 Enrollment ID: I20241030003632 |
| Provider Name | Juan R Vigo Matos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508444225 PECOS PAC ID: 5395145981 Enrollment ID: I20241104002410 |
| Provider Name | Elizabeth Kay Corey-pacheco |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689018913 PECOS PAC ID: 8022337872 Enrollment ID: I20241209001595 |
| Provider Name | Evan M Sugar |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962173716 PECOS PAC ID: 3173910205 Enrollment ID: I20250108002478 |
| Provider Name | Bradley Scott Chotiner |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1962469528 PECOS PAC ID: 8921057233 Enrollment ID: I20250117002057 |
| Provider Name | Heather R Grabowski |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184121014 PECOS PAC ID: 0446582977 Enrollment ID: I20250415002489 |
| Provider Name | Matthew J Belanger |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1811481310 PECOS PAC ID: 9739437146 Enrollment ID: I20250529000387 |
| Provider Name | Judith Sarah Grimm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114595980 PECOS PAC ID: 6709289689 Enrollment ID: I20250625004053 |
| Provider Name | Jacob R Ortiz |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1215294749 PECOS PAC ID: 6507178563 Enrollment ID: I20250729000148 |
| Provider Name | Jennie Boisvert |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1427772375 PECOS PAC ID: 1951763598 Enrollment ID: I20250808000147 |
| Provider Name | Anna Marie Goodwin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1124778881 PECOS PAC ID: 1557862026 Enrollment ID: I20250827004789 |
| Provider Name | Andrew K Merritt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932839107 PECOS PAC ID: 2163803875 Enrollment ID: I20250829000364 |
| Provider Name | Jacqueline Alexandra Strong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255844700 PECOS PAC ID: 6002297371 Enrollment ID: I20250919004083 |
| Provider Name | Haley Loptien |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1588394878 PECOS PAC ID: 8022499557 Enrollment ID: I20250920000033 |
| Provider Name | Mina Guirguis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184373573 PECOS PAC ID: 9133504376 Enrollment ID: I20251003000793 |
| Provider Name | Christopher Glenn Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295232684 PECOS PAC ID: 9931594934 Enrollment ID: I20251006001253 |
| Provider Name | Eugene Azubike Nwosu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1871518068 PECOS PAC ID: 8729139274 Enrollment ID: I20251030001250 |
| Provider Name | Shannon Haenel |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1811124365 PECOS PAC ID: 9032373451 Enrollment ID: I20251124002788 |
| Provider Name | Deborah Holcomb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407801632 PECOS PAC ID: 0840277406 Enrollment ID: I20260121002601 |
| Provider Name | Donald Irwin Lowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528925765 PECOS PAC ID: 2264912344 Enrollment ID: I20260217002564 |
| Provider Name | Muhammad Hamza Rafique |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235512948 PECOS PAC ID: 5597061481 Enrollment ID: I20260430002830 |
Georgetown Pediatric Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 57 Jessamine Ave, Georgetown, SC 29440 Phone: 843-546-8686 Fax: 843-546-1353 |
Waccamaw Endoscopy Center, LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2361 North Fraser Street, Georgetown, SC 29440 Phone: 843-527-3428 |
Ovp Health Care, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1423 Winyah St, Georgetown, SC 29440 Phone: 304-429-1088 Fax: 304-429-3109 |
Tidelands Health Gastroenterology Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1011 N Fraser St, Georgetown, SC 29440 Phone: 843-527-3428 Fax: 843-546-8216 |
Georgetown Health Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1075 N Fraser St, Georgetown, SC 29440 Phone: 843-527-4442 |
Carehere LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1745 N Fraser St, Georgetown, SC 29440 Phone: 615-221-5901 |