| Loyola Medical Group LLC | |
|
3249 Oak Park Ave Berwyn IL 60402-3429 | |
| (708) 783-3125 | |
| Not Available |
| Full Name | Loyola Medical Group LLC |
|---|---|
| Speciality | General Practice |
| Location | 3249 Oak Park Ave, Berwyn, Illinois |
| Authorized Official Name and Position | Adenrele Adekunbi Kolawole (DIRECTOR BILLING OPERATIONS) |
| Authorized Official Contact | 7082163743 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Loyola Medical Group LLC 2160 S 1st Ave Maywood IL 60153-3328 | Loyola Medical Group LLC 3249 Oak Park Ave Berwyn IL 60402-3429 Ph: (708) 783-3125 |
| NPI Number | 1376041954 |
|---|---|
| Provider Enumeration Date | 01/29/2018 |
| Last Update Date | 07/01/2026 |
| Certification Date | 07/01/2026 |
| Medicare PECOS PAC ID | 6305109547 |
|---|---|
| Medicare Enrollment ID | O20180420002063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376041954 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (NU) | Primary |
| Provider Name | Roselia Herrera Villasenor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124066162 PECOS PAC ID: 5597679142 Enrollment ID: I20031205000546 |
| Provider Name | Francisco Javier Espinosa-becerra |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1881646313 PECOS PAC ID: 8224930011 Enrollment ID: I20040122000755 |
| Provider Name | Susan H Porto |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1487643573 PECOS PAC ID: 6608767645 Enrollment ID: I20040322000328 |
| Provider Name | Paula White Prock |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1619941762 PECOS PAC ID: 1153314828 Enrollment ID: I20040407000873 |
| Provider Name | Joseph M Bresnahan |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1710925532 PECOS PAC ID: 4284623760 Enrollment ID: I20040709000960 |
| Provider Name | Amit K Srivastava |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1770521510 PECOS PAC ID: 2668461138 Enrollment ID: I20040709001090 |
| Provider Name | David B Levy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437101714 PECOS PAC ID: 6709859119 Enrollment ID: I20040820000819 |
| Provider Name | Sandra Vega |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1760454979 PECOS PAC ID: 3476520909 Enrollment ID: I20040914001042 |
| Provider Name | Leticia Gonzalez |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1356313720 PECOS PAC ID: 3375511553 Enrollment ID: I20040924000518 |
| Provider Name | Alka Srivastava |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1982672663 PECOS PAC ID: 9234170424 Enrollment ID: I20050518000505 |
| Provider Name | Ge Li |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1891801064 PECOS PAC ID: 4587691969 Enrollment ID: I20050719000155 |
| Provider Name | Thomas Maynard Tucker Turk |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1568436541 PECOS PAC ID: 4688602683 Enrollment ID: I20050801000506 |
| Provider Name | James a Rupp |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780658815 PECOS PAC ID: 1658301833 Enrollment ID: I20050817000505 |
| Provider Name | Douglas a Evans |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1700850005 PECOS PAC ID: 9638109416 Enrollment ID: I20050822000570 |
| Provider Name | Gerald Ambrose Charnogursky |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1023097102 PECOS PAC ID: 0648201269 Enrollment ID: I20050824000041 |
| Provider Name | Parag K Amin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639107667 PECOS PAC ID: 4486685872 Enrollment ID: I20050825000441 |
| Provider Name | Jeffrey K Zawacki |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1790774750 PECOS PAC ID: 0042239386 Enrollment ID: I20051116000588 |
| Provider Name | Mithila Janakiram |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750313961 PECOS PAC ID: 2668494501 Enrollment ID: I20051220000756 |
| Provider Name | Laura Saelinger Shafer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598739633 PECOS PAC ID: 1759396633 Enrollment ID: I20060214000327 |
| Provider Name | Arlette F Brown |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1275580565 PECOS PAC ID: 8426060898 Enrollment ID: I20060629000269 |
| Provider Name | Ryan C Headley |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659309375 PECOS PAC ID: 4688677719 Enrollment ID: I20060810000342 |
| Provider Name | Baudelio Herrada |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366466898 PECOS PAC ID: 9335142272 Enrollment ID: I20060816000085 |
| Provider Name | Alina V Merrill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710909890 PECOS PAC ID: 1254334733 Enrollment ID: I20060823000385 |
| Provider Name | Madalina Ionescu |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1306878558 PECOS PAC ID: 1759359086 Enrollment ID: I20060907000446 |
| Provider Name | Raul Tamayo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700814183 PECOS PAC ID: 3173527694 Enrollment ID: I20060914000045 |
| Provider Name | Ramon Alvarez Leonardo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861425365 PECOS PAC ID: 9335144484 Enrollment ID: I20060922000282 |
| Provider Name | David Czukerberg |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578515839 PECOS PAC ID: 7012915846 Enrollment ID: I20061110000016 |
| Provider Name | Syed Rizvi |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1598840399 PECOS PAC ID: 4880695865 Enrollment ID: I20070117000290 |
| Provider Name | Louise E Komorek |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1366577835 PECOS PAC ID: 1658479894 Enrollment ID: I20070612000128 |
| Provider Name | Michael Edward Woods |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1366541351 PECOS PAC ID: 8022112358 Enrollment ID: I20070713000717 |
| Provider Name | Deslyn S Browne |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1083827810 PECOS PAC ID: 4082705256 Enrollment ID: I20070802000611 |
| Provider Name | Darius J Bartkus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093836629 PECOS PAC ID: 5496849036 Enrollment ID: I20070913000438 |
| Provider Name | Michael V Gavino |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1538352539 PECOS PAC ID: 6103911797 Enrollment ID: I20070927000286 |
| Provider Name | Tamajah M Jordan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093931198 PECOS PAC ID: 1951401256 Enrollment ID: I20070928000474 |
| Provider Name | Steve Michel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053340695 PECOS PAC ID: 6608956925 Enrollment ID: I20071227000519 |
| Provider Name | Mark E Hroncich |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265465108 PECOS PAC ID: 9032299607 Enrollment ID: I20080108000864 |
| Provider Name | Brian Ralston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710917109 PECOS PAC ID: 0840370417 Enrollment ID: I20080108000871 |
| Provider Name | Christopher R Thorp |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1730127739 PECOS PAC ID: 5991886293 Enrollment ID: I20080111000706 |
| Provider Name | Mohammed T Ali |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033215868 PECOS PAC ID: 1456432160 Enrollment ID: I20080121000069 |
| Provider Name | Janis Wiener |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750315586 PECOS PAC ID: 2567547094 Enrollment ID: I20080308000019 |
| Provider Name | Elsa Valero |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033383088 PECOS PAC ID: 4587733688 Enrollment ID: I20080515000249 |
| Provider Name | Hong S Lee |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1023289444 PECOS PAC ID: 7113098039 Enrollment ID: I20080620000375 |
| Provider Name | Kristina Aleksoniene |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1659545002 PECOS PAC ID: 6901978139 Enrollment ID: I20080703000507 |
| Provider Name | Syed Waliuddin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104046630 PECOS PAC ID: 1658463534 Enrollment ID: I20080924000549 |
| Provider Name | Stefanie a Allen |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1114192416 PECOS PAC ID: 6800964404 Enrollment ID: I20081009000459 |
| Provider Name | Mary Tillema |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346214319 PECOS PAC ID: 5496817371 Enrollment ID: I20081231000348 |
| Provider Name | James G Martin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235382011 PECOS PAC ID: 7214091966 Enrollment ID: I20090126000348 |
| Provider Name | Rick Chadha |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1992770598 PECOS PAC ID: 0648337030 Enrollment ID: I20090331000109 |
| Provider Name | Gregory J Ozark |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558337840 PECOS PAC ID: 3476602301 Enrollment ID: I20090522000261 |
| Provider Name | Louis E De La Garza |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1740448323 PECOS PAC ID: 6002968575 Enrollment ID: I20090714000422 |
| Provider Name | Mark S Choh |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1023283611 PECOS PAC ID: 5890848626 Enrollment ID: I20090727000705 |
| Provider Name | Yongsun L Ra- Hurka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821062944 PECOS PAC ID: 6305988114 Enrollment ID: I20100116000077 |
| Provider Name | Aaron Donald Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265690523 PECOS PAC ID: 0648314658 Enrollment ID: I20100215000219 |
| Provider Name | Quang D Pham |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1932212180 PECOS PAC ID: 5799800389 Enrollment ID: I20100920000867 |
| Provider Name | John L Bertolozzi |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1407869779 PECOS PAC ID: 1951426543 Enrollment ID: I20100920000890 |
| Provider Name | Bobby Chan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154588440 PECOS PAC ID: 6305038316 Enrollment ID: I20101008000862 |
| Provider Name | Edward C Foley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164440475 PECOS PAC ID: 1557553120 Enrollment ID: I20101014000712 |
| Provider Name | Yvonne T Murphy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801825450 PECOS PAC ID: 5890988489 Enrollment ID: I20101014001051 |
| Provider Name | Sarkis Morales Vidal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811211899 PECOS PAC ID: 4587858592 Enrollment ID: I20101103001363 |
| Provider Name | Olga M Vila-sola |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1396925137 PECOS PAC ID: 3870780034 Enrollment ID: I20101214000653 |
| Provider Name | Davis P Yang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659305712 PECOS PAC ID: 7315135829 Enrollment ID: I20101228000822 |
| Provider Name | May Hashimi |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1154342293 PECOS PAC ID: 8022297233 Enrollment ID: I20110120000317 |
| Provider Name | Jennifer M Sardone-ponnappan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851599583 PECOS PAC ID: 7618069972 Enrollment ID: I20110221000098 |
| Provider Name | Melissa N Toulios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912207036 PECOS PAC ID: 4880877018 Enrollment ID: I20110325000575 |
| Provider Name | Thythy T Pham |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1285880757 PECOS PAC ID: 8527245992 Enrollment ID: I20110613000205 |
| Provider Name | Robin L Favor |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1912153909 PECOS PAC ID: 8628124682 Enrollment ID: I20110627000670 |
| Provider Name | Gregory P Macaluso |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1831355585 PECOS PAC ID: 4587832621 Enrollment ID: I20110715000646 |
| Provider Name | Lisa C Juarez |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1568625465 PECOS PAC ID: 0446428460 Enrollment ID: I20110720000571 |
| Provider Name | Nicole M Sprawka |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1659534055 PECOS PAC ID: 1052581436 Enrollment ID: I20110822000180 |
| Provider Name | Gopal N Gupta |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1326182015 PECOS PAC ID: 4587835111 Enrollment ID: I20110912000550 |
| Provider Name | Margaret Liotta |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1841454303 PECOS PAC ID: 3476605494 Enrollment ID: I20110914000286 |
| Provider Name | Ahmer V Farooq |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1326201666 PECOS PAC ID: 3375714728 Enrollment ID: I20110915000722 |
| Provider Name | Christina Arellano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396907796 PECOS PAC ID: 9638341233 Enrollment ID: I20111003000758 |
| Provider Name | Nina Yedavalli |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1306094842 PECOS PAC ID: 0749200541 Enrollment ID: I20111109000701 |
| Provider Name | Jenny R.s Handa |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1063789071 PECOS PAC ID: 5496922593 Enrollment ID: I20120112000452 |
| Provider Name | Joseph J Alioto |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1164685525 PECOS PAC ID: 2062679657 Enrollment ID: I20120209000559 |
| Provider Name | Ann K Lal |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1518163401 PECOS PAC ID: 4284792094 Enrollment ID: I20120404000972 |
| Provider Name | Sameer M a Qazi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1083842868 PECOS PAC ID: 8820259351 Enrollment ID: I20120410000703 |
| Provider Name | Michael R Miller |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1730470493 PECOS PAC ID: 9133306418 Enrollment ID: I20120511000332 |
| Provider Name | Andrei V Pankov |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225285703 PECOS PAC ID: 8022273770 Enrollment ID: I20120629000528 |
| Provider Name | Komal Kaul |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962710798 PECOS PAC ID: 2466617691 Enrollment ID: I20120712000839 |
| Provider Name | Sarah E Perkins |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1013173061 PECOS PAC ID: 3870743610 Enrollment ID: I20121101000243 |
| Provider Name | Jude Dumfeh |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1700048022 PECOS PAC ID: 6901058387 Enrollment ID: I20121211000241 |
| Provider Name | Casey G Shupe |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1982867446 PECOS PAC ID: 6608029699 Enrollment ID: I20121221000370 |
| Provider Name | Samir H Navik |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1487814695 PECOS PAC ID: 2961655105 Enrollment ID: I20130121000078 |
| Provider Name | Candace R Blank |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1194056564 PECOS PAC ID: 1951555010 Enrollment ID: I20130126000019 |
| Provider Name | Diorella C Guloy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477782597 PECOS PAC ID: 2961640305 Enrollment ID: I20130524000400 |
| Provider Name | Jolene M Quinones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750624581 PECOS PAC ID: 5395985162 Enrollment ID: I20130628000457 |
| Provider Name | Lena R Wiley |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1164665386 PECOS PAC ID: 2668616558 Enrollment ID: I20130916000206 |
| Provider Name | Shuja M Uddin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871832790 PECOS PAC ID: 0840425831 Enrollment ID: I20131029000596 |
| Provider Name | Nereida Esparza |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013233006 PECOS PAC ID: 6305071051 Enrollment ID: I20131105000730 |
| Provider Name | Eliza J Pierko |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659680015 PECOS PAC ID: 3375773914 Enrollment ID: I20140227001995 |
| Provider Name | Shilpa V Desai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063552412 PECOS PAC ID: 4284772294 Enrollment ID: I20140502001180 |
| Provider Name | Anne Groves |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699948786 PECOS PAC ID: 8921222043 Enrollment ID: I20140611001780 |
| Provider Name | Meghan Cox-pedota |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1144541657 PECOS PAC ID: 2668694969 Enrollment ID: I20141120001083 |
| Provider Name | Jacquelyn N Skerrett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457611683 PECOS PAC ID: 0042433906 Enrollment ID: I20150723006712 |
| Provider Name | Dejan Micic |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1356660203 PECOS PAC ID: 8921308834 Enrollment ID: I20151125001579 |
| Provider Name | Neel B Patel |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1700102332 PECOS PAC ID: 1557675741 Enrollment ID: I20160608000147 |
| Provider Name | Joana R Lopes Perdigao |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1992067094 PECOS PAC ID: 9133422611 Enrollment ID: I20160728002330 |
| Provider Name | Abigail Winder |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1740423623 PECOS PAC ID: 8921250507 Enrollment ID: I20160816001800 |
| Provider Name | Wayne Yang |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1730319336 PECOS PAC ID: 3173755170 Enrollment ID: I20161010001177 |
| Provider Name | Melissa Marie Arredondo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508120981 PECOS PAC ID: 6204139256 Enrollment ID: I20161012002959 |
| Provider Name | Jennifer Holland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366573495 PECOS PAC ID: 9032357140 Enrollment ID: I20161202000417 |
| Provider Name | Magdaline V Piatek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588899454 PECOS PAC ID: 9133342371 Enrollment ID: I20161209000133 |
| Provider Name | Samer Totonchi |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1467689281 PECOS PAC ID: 5092948570 Enrollment ID: I20170119002247 |
| Provider Name | Grant Balbarin |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1891237095 PECOS PAC ID: 4486930021 Enrollment ID: I20170413000776 |
| Provider Name | Aditi Puri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578882221 PECOS PAC ID: 2769622265 Enrollment ID: I20170526000060 |
| Provider Name | Christopher Ochoa |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1952690182 PECOS PAC ID: 5193028314 Enrollment ID: I20170619000444 |
| Provider Name | Sheila B Atendido |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1609308139 PECOS PAC ID: 1052680592 Enrollment ID: I20170627001544 |
| Provider Name | Eugene Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770841678 PECOS PAC ID: 2961713953 Enrollment ID: I20170818002595 |
| Provider Name | Antonio Hernando Iglesias |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1003142704 PECOS PAC ID: 8921228834 Enrollment ID: I20171113001999 |
| Provider Name | Krzysztof Malewicz |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1609383496 PECOS PAC ID: 1052669652 Enrollment ID: I20180730001138 |
| Provider Name | Elizabeth Torres |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1194806711 PECOS PAC ID: 1052461084 Enrollment ID: I20180815003371 |
| Provider Name | Kathleen Patricia Medici |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104315571 PECOS PAC ID: 4183974991 Enrollment ID: I20180828004213 |
| Provider Name | Alexander P Soneru |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1558656033 PECOS PAC ID: 9638446388 Enrollment ID: I20180910002090 |
| Provider Name | Marian Giselle Acevedo Alvarez |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1710271341 PECOS PAC ID: 1456649045 Enrollment ID: I20180919001916 |
| Provider Name | Solomon Krow |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1417219379 PECOS PAC ID: 0345557781 Enrollment ID: I20180919003816 |
| Provider Name | Virginia Dunsmore |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1396996518 PECOS PAC ID: 0840541306 Enrollment ID: I20180921001250 |
| Provider Name | Bianca Rische |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1013490721 PECOS PAC ID: 0143573154 Enrollment ID: I20181022000666 |
| Provider Name | Madeline Lubenow |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1265996631 PECOS PAC ID: 6204176860 Enrollment ID: I20190318001082 |
| Provider Name | Heather Bartusek |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1659936763 PECOS PAC ID: 8921331661 Enrollment ID: I20190611003146 |
| Provider Name | Anila Naz Khan |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1730537986 PECOS PAC ID: 4183916000 Enrollment ID: I20190619000419 |
| Provider Name | Gifty Susan Abraham |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1881039279 PECOS PAC ID: 3072746031 Enrollment ID: I20190816003023 |
| Provider Name | Jigisha Paresh Thakkar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1750795696 PECOS PAC ID: 4183938079 Enrollment ID: I20190823002632 |
| Provider Name | Priyanka Sultania Dudani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316255847 PECOS PAC ID: 5890922678 Enrollment ID: I20191216000245 |
| Provider Name | Neeraj Joshi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1902249683 PECOS PAC ID: 9436374394 Enrollment ID: I20200326001144 |
| Provider Name | Carlos A. Marin |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1194257204 PECOS PAC ID: 4385073832 Enrollment ID: I20200403000939 |
| Provider Name | Hemlatta Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366075319 PECOS PAC ID: 0648601658 Enrollment ID: I20200507000339 |
| Provider Name | Tyler Cohn |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1881958098 PECOS PAC ID: 0840572202 Enrollment ID: I20200521000369 |
| Provider Name | Jennifer K Yang |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386279677 PECOS PAC ID: 2769803584 Enrollment ID: I20200603002682 |
| Provider Name | Hemlata Meena |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1629280839 PECOS PAC ID: 6709923550 Enrollment ID: I20200724002132 |
| Provider Name | Jacqueline Ann Kalmoe |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1528486032 PECOS PAC ID: 7214233923 Enrollment ID: I20200904000074 |
| Provider Name | Layan Alrahmani |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912294455 PECOS PAC ID: 5294046264 Enrollment ID: I20200917001177 |
| Provider Name | Adriana Russ |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1295208890 PECOS PAC ID: 3577982966 Enrollment ID: I20201005001378 |
| Provider Name | Rebecca Rajasekhar |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1376090878 PECOS PAC ID: 7214357433 Enrollment ID: I20201008003066 |
| Provider Name | Lisa Meraz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790323657 PECOS PAC ID: 3476969916 Enrollment ID: I20210309001488 |
| Provider Name | David B White |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1407310717 PECOS PAC ID: 1557601887 Enrollment ID: I20210319001421 |
| Provider Name | Ahmad Mahgiub El-arabi |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1740636398 PECOS PAC ID: 5294021739 Enrollment ID: I20210701001601 |
| Provider Name | Adam Hintz |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1427444884 PECOS PAC ID: 3678866712 Enrollment ID: I20210727003935 |
| Provider Name | Tiffany a Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679157473 PECOS PAC ID: 6204230170 Enrollment ID: I20210814000219 |
| Provider Name | Cameron Killen |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1811376437 PECOS PAC ID: 6103126073 Enrollment ID: I20210826002537 |
| Provider Name | Alexander Kuzma |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1760864995 PECOS PAC ID: 7810282241 Enrollment ID: I20210907002870 |
| Provider Name | Robert L Brochin |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1225423791 PECOS PAC ID: 7810233137 Enrollment ID: I20210910001772 |
| Provider Name | Zohaib Haque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215422142 PECOS PAC ID: 3173876950 Enrollment ID: I20210913002989 |
| Provider Name | Surina R Kumar |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1104271352 PECOS PAC ID: 1052604980 Enrollment ID: I20210915000153 |
| Provider Name | Sirisha Yellayi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619473519 PECOS PAC ID: 3375894462 Enrollment ID: I20210915001139 |
| Provider Name | Ruta Cepaitis |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1568993426 PECOS PAC ID: 1557633963 Enrollment ID: I20210924002493 |
| Provider Name | Richard Lawley |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1063825925 PECOS PAC ID: 3678877651 Enrollment ID: I20211012000139 |
| Provider Name | Arshnoor Qamaruddin |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1649841339 PECOS PAC ID: 8527457407 Enrollment ID: I20211115002223 |
| Provider Name | Alec Johnson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1295499325 PECOS PAC ID: 6608266184 Enrollment ID: I20211124002158 |
| Provider Name | Steve Fankam |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1255910014 PECOS PAC ID: 8628468667 Enrollment ID: I20211206000806 |
| Provider Name | Syed J Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407807746 PECOS PAC ID: 8224035480 Enrollment ID: I20220114001441 |
| Provider Name | Tianyi Swartz |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1912402405 PECOS PAC ID: 8527317270 Enrollment ID: I20220602001397 |
| Provider Name | Tonia Gooden |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1962065623 PECOS PAC ID: 4789915042 Enrollment ID: I20220715000211 |
| Provider Name | Christopher Gozali |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598225773 PECOS PAC ID: 6103208699 Enrollment ID: I20220730000133 |
| Provider Name | Nikolas Baksh |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1306232467 PECOS PAC ID: 7618286261 Enrollment ID: I20220802003173 |
| Provider Name | Kirsten Aimee Sorum |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477818912 PECOS PAC ID: 7911393244 Enrollment ID: I20220805002240 |
| Provider Name | Matthew Hall |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1306293915 PECOS PAC ID: 8426346792 Enrollment ID: I20220808001929 |
| Provider Name | Jessica Imuetinyan Obeahon |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1730743402 PECOS PAC ID: 0648653832 Enrollment ID: I20220822001170 |
| Provider Name | John Patrick Richgels |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1053760132 PECOS PAC ID: 5799077186 Enrollment ID: I20220831001843 |
| Provider Name | Elizabeth Anne Paganessi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1548754518 PECOS PAC ID: 5597140475 Enrollment ID: I20220913001618 |
| Provider Name | Syed Ghazanfar Hasan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053809442 PECOS PAC ID: 4981070919 Enrollment ID: I20221017002360 |
| Provider Name | Elizabeth Ann Murphy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669108460 PECOS PAC ID: 4486023652 Enrollment ID: I20221209001318 |
| Provider Name | Rebecca J Burkhart |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1962124347 PECOS PAC ID: 7911376959 Enrollment ID: I20221213002694 |
| Provider Name | Shae Cenkus |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1598341273 PECOS PAC ID: 9032517263 Enrollment ID: I20221219000443 |
| Provider Name | Megan Lobner |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1003537002 PECOS PAC ID: 0446621676 Enrollment ID: I20230125001745 |
| Provider Name | Verna L Auge |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1255430039 PECOS PAC ID: 7113943168 Enrollment ID: I20230215001782 |
| Provider Name | Kathleen Kennedy |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1821522871 PECOS PAC ID: 5890030902 Enrollment ID: I20230615002091 |
| Provider Name | Aaron M Gish |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1063971844 PECOS PAC ID: 2264897107 Enrollment ID: I20230623002846 |
| Provider Name | Adeel a Yaseen |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1841759735 PECOS PAC ID: 0941543599 Enrollment ID: I20230714001551 |
| Provider Name | Matthew Lo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154958627 PECOS PAC ID: 5698185338 Enrollment ID: I20230726002557 |
| Provider Name | Kyle Mieszcak |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1417624206 PECOS PAC ID: 2365803533 Enrollment ID: I20230803003344 |
| Provider Name | Sarah Finucane |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1235633629 PECOS PAC ID: 5799034385 Enrollment ID: I20230808003959 |
| Provider Name | Elaine Cheng |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992122915 PECOS PAC ID: 7113229816 Enrollment ID: I20230809002349 |
| Provider Name | Yoojung Kang |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1346705316 PECOS PAC ID: 3476893785 Enrollment ID: I20230810000055 |
| Provider Name | Muhaimeen Shagir Hossain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205463981 PECOS PAC ID: 2769845486 Enrollment ID: I20230829002001 |
| Provider Name | Jennifer Weiss |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1346771698 PECOS PAC ID: 3375814288 Enrollment ID: I20230907001739 |
| Provider Name | Kevin C Brown |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1528413325 PECOS PAC ID: 8426340241 Enrollment ID: I20230911001505 |
| Provider Name | Brittany Idusuyi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1639730302 PECOS PAC ID: 9133456569 Enrollment ID: I20230911003604 |
| Provider Name | Laura Rios-coste |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1801679626 PECOS PAC ID: 5395191134 Enrollment ID: I20231030003734 |
| Provider Name | Stephanie Rodriguez |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1508337932 PECOS PAC ID: 5294196382 Enrollment ID: I20231113001287 |
| Provider Name | Imran M Puthawala |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1952780637 PECOS PAC ID: 0941519813 Enrollment ID: I20231121001362 |
| Provider Name | Julie Graf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114508272 PECOS PAC ID: 4981005568 Enrollment ID: I20231206000675 |
| Provider Name | Genesis Talia Mancha |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750905097 PECOS PAC ID: 3072938083 Enrollment ID: I20240313002769 |
| Provider Name | Chris Du |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1366900508 PECOS PAC ID: 1456683523 Enrollment ID: I20240510000496 |
| Provider Name | Mit Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245816792 PECOS PAC ID: 4183033467 Enrollment ID: I20240806002181 |
| Provider Name | Mansi Singapori |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1396240461 PECOS PAC ID: 1355697491 Enrollment ID: I20240823000843 |
| Provider Name | Thomas Hodo |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1760976203 PECOS PAC ID: 0648682062 Enrollment ID: I20240823002756 |
| Provider Name | Amira Elshikh |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1215434220 PECOS PAC ID: 6608264247 Enrollment ID: I20240912004058 |
| Provider Name | Abraham Nereim Baker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104404748 PECOS PAC ID: 3072901032 Enrollment ID: I20240923003112 |
| Provider Name | Kathryn Patton |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326676057 PECOS PAC ID: 8628469343 Enrollment ID: I20241017001500 |
| Provider Name | Mohamad K Khasawneh |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1467403006 PECOS PAC ID: 2163429432 Enrollment ID: I20241024003872 |
| Provider Name | Julia Marjory Coughlin |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1629430491 PECOS PAC ID: 3072896463 Enrollment ID: I20241114001761 |
| Provider Name | Meghan Thakur |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1780115675 PECOS PAC ID: 2163757295 Enrollment ID: I20241125002060 |
| Provider Name | Scyler Hodo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386479210 PECOS PAC ID: 2668995192 Enrollment ID: I20250325004089 |
| Provider Name | Chirag Rajyaguru |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1326434937 PECOS PAC ID: 0345628855 Enrollment ID: I20250410001669 |
| Provider Name | Grant M Van Der Voort |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1396372405 PECOS PAC ID: 0941624993 Enrollment ID: I20250509001007 |
| Provider Name | Alejandro Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154066827 PECOS PAC ID: 4981086808 Enrollment ID: I20250630002723 |
| Provider Name | Eugene Park |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780244020 PECOS PAC ID: 5597278457 Enrollment ID: I20250702003515 |
| Provider Name | Frank Woo |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1477132363 PECOS PAC ID: 5395250229 Enrollment ID: I20250711000424 |
| Provider Name | Ayaz Gen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508447061 PECOS PAC ID: 5496268955 Enrollment ID: I20250715002417 |
| Provider Name | Enrique Blanco Martinez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518606227 PECOS PAC ID: 1052792546 Enrollment ID: I20250724003572 |
| Provider Name | Ethan Johnston |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457939142 PECOS PAC ID: 9133521016 Enrollment ID: I20250812000522 |
| Provider Name | Mary Jean Murphy |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1922686898 PECOS PAC ID: 2668973801 Enrollment ID: I20250829000788 |
| Provider Name | Kavya Bindu Poluru |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639819519 PECOS PAC ID: 3577067487 Enrollment ID: I20250915004058 |
| Provider Name | Yixin Xu |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1639758048 PECOS PAC ID: 0345772000 Enrollment ID: I20250918003259 |
| Provider Name | Erika Hripko |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417539396 PECOS PAC ID: 5698177202 Enrollment ID: I20251211003074 |
| Provider Name | Reid Stubbee |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1578197497 PECOS PAC ID: 9739581067 Enrollment ID: I20260609003611 |
| Provider Name | Lauren Barber |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1255863882 PECOS PAC ID: 7113264383 Enrollment ID: I20260624001231 |
Healthy Hearts Doctors LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6920 Ogden Ave, Berwyn, IL 60402 Phone: 630-847-9795 Fax: 630-780-2991 |
Gottlieb Community Health Services Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3249 Oak Park Ave, Berwyn, IL 60402 Phone: 708-783-3125 |
Berwyn Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3245 S. Grove Avenue, Ste 105 & 106, Berwyn, IL 60402 Phone: 708-795-0383 Fax: 708-484-9545 |
Macneal Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3249 South Oak Park Ave, Berwyn, IL 60402 Phone: 708-783-3222 Fax: 708-783-3489 |
South Family Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6201 Roosevelt Rd, Berwyn, IL 60402 Phone: 708-386-0845 Fax: 708-386-8472 |
Vanguard Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3249 Oak Park Ave, Berwyn, IL 60402 Phone: 708-783-3222 Fax: 708-783-3489 |