| Medical Education Assistance Corporation | |
|
101 Med Tech Pkwy Ste 306 Johnson City TN 37604-4001 | |
| (423) 433-6039 | |
| (423) 433-6060 |
| Full Name | Medical Education Assistance Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 101 Med Tech Pkwy Ste 306, Johnson City, Tennessee |
| Authorized Official Name and Position | Russell E Lewis (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4234336050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Education Assistance Corporation Po Box 699 Mountain Home TN 37684-0699 Ph: (423) 433-6039 | Medical Education Assistance Corporation 101 Med Tech Pkwy Ste 306 Johnson City TN 37604-4001 Ph: (423) 433-6039 |
| NPI Number | 1235180480 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 01/14/2026 |
| Medicare PECOS PAC ID | 3870491269 |
|---|---|
| Medicare Enrollment ID | O20040206000795 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235180480 | NPI | - | NPPES |
| Provider Name | Peter R Bockhorst |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336143866 PECOS PAC ID: 3274429618 Enrollment ID: I20040224000465 |
| Provider Name | Gregory E Clarity |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568451516 PECOS PAC ID: 2163311531 Enrollment ID: I20040312001199 |
| Provider Name | Ralph L Mills |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1942295894 PECOS PAC ID: 9335031376 Enrollment ID: I20040325001408 |
| Provider Name | Karen E Schetzina |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1104814987 PECOS PAC ID: 0648264374 Enrollment ID: I20040414000356 |
| Provider Name | Marc A Fagelson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1760413116 PECOS PAC ID: 2365437811 Enrollment ID: I20040415000783 |
| Provider Name | Ann M Rouse |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1619960713 PECOS PAC ID: 7113902073 Enrollment ID: I20040623001077 |
| Provider Name | George M Testerman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1033107859 PECOS PAC ID: 7911985627 Enrollment ID: I20040709000635 |
| Provider Name | Don E Adams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245215847 PECOS PAC ID: 6709866817 Enrollment ID: I20040721000138 |
| Provider Name | Jaime G Oakley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013966886 PECOS PAC ID: 2062492754 Enrollment ID: I20040722001233 |
| Provider Name | John G Heise |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1962405787 PECOS PAC ID: 5496726267 Enrollment ID: I20040804001184 |
| Provider Name | Dawn S Tuell |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356339758 PECOS PAC ID: 2466423165 Enrollment ID: I20040805000180 |
| Provider Name | Thomas W Bishop |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760480966 PECOS PAC ID: 1557333986 Enrollment ID: I20040806001056 |
| Provider Name | Ginger W Carter |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1831143106 PECOS PAC ID: 9830162478 Enrollment ID: I20040812001546 |
| Provider Name | Lee A Colyar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386626166 PECOS PAC ID: 3375503626 Enrollment ID: I20041013000327 |
| Provider Name | Wael Shams |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1265420046 PECOS PAC ID: 9931160215 Enrollment ID: I20041020000667 |
| Provider Name | Fereshteh Gerayli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861478661 PECOS PAC ID: 5193781631 Enrollment ID: I20041206001111 |
| Provider Name | Anna B Gilbert |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285610931 PECOS PAC ID: 7810945862 Enrollment ID: I20050106000808 |
| Provider Name | Parasbhai D Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245217504 PECOS PAC ID: 8325098270 Enrollment ID: I20050127000861 |
| Provider Name | Ahmad A Wattad |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1174511588 PECOS PAC ID: 2567416530 Enrollment ID: I20050311000765 |
| Provider Name | Peter B Platzer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285637124 PECOS PAC ID: 7911945076 Enrollment ID: I20050419001323 |
| Provider Name | Michael Allshouse |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093809329 PECOS PAC ID: 2860429461 Enrollment ID: I20050803000989 |
| Provider Name | Rashid Mahboob |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659356335 PECOS PAC ID: 4789613977 Enrollment ID: I20050808001101 |
| Provider Name | Sheri L Holmes |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588626840 PECOS PAC ID: 5597795492 Enrollment ID: I20050819000859 |
| Provider Name | Lesli A Taylor |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1508854324 PECOS PAC ID: 5890726145 Enrollment ID: I20050825000933 |
| Provider Name | Christopher R Mitchell |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1831190479 PECOS PAC ID: 0143245134 Enrollment ID: I20051021000451 |
| Provider Name | Jon W Jones |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1396701405 PECOS PAC ID: 3971520867 Enrollment ID: I20051031000275 |
| Provider Name | Amy L Haynes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871543926 PECOS PAC ID: 3375561244 Enrollment ID: I20051109000457 |
| Provider Name | James R Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003884412 PECOS PAC ID: 4183643745 Enrollment ID: I20051114000676 |
| Provider Name | Stephanie C Manginelli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225010010 PECOS PAC ID: 3577523737 Enrollment ID: I20051116000113 |
| Provider Name | Paul Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588628705 PECOS PAC ID: 4082633151 Enrollment ID: I20051117000536 |
| Provider Name | Daniel F Haynes |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1306839360 PECOS PAC ID: 4981623725 Enrollment ID: I20051122000155 |
| Provider Name | Rebecca J Copeland |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720071814 PECOS PAC ID: 4981625050 Enrollment ID: I20051216000236 |
| Provider Name | Phillip J Riley |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1043284391 PECOS PAC ID: 7810919735 Enrollment ID: I20051220000578 |
| Provider Name | Ronald C Hamdy |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1508859562 PECOS PAC ID: 8820005994 Enrollment ID: I20060314000678 |
| Provider Name | Glenda Frances Stockwell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952369613 PECOS PAC ID: 8022025956 Enrollment ID: I20060316000541 |
| Provider Name | John K Smith |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1972771012 PECOS PAC ID: 3375553589 Enrollment ID: I20060503000224 |
| Provider Name | Stanley M Hodges |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609851351 PECOS PAC ID: 8628074234 Enrollment ID: I20061004000400 |
| Provider Name | Joseph R Lee |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1578504395 PECOS PAC ID: 6507862117 Enrollment ID: I20061004000423 |
| Provider Name | Mirle Girish |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1205872876 PECOS PAC ID: 8325044514 Enrollment ID: I20061011000389 |
| Provider Name | Chadi M Jarjoura |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1407834211 PECOS PAC ID: 7416955083 Enrollment ID: I20061114000307 |
| Provider Name | Sean P White |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912961764 PECOS PAC ID: 5193727683 Enrollment ID: I20070213000436 |
| Provider Name | Thomas R Avonda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407920101 PECOS PAC ID: 0941202295 Enrollment ID: I20070215000348 |
| Provider Name | John R Hereford |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1619931557 PECOS PAC ID: 3072615178 Enrollment ID: I20070220000522 |
| Provider Name | Christy L Stevens |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578507950 PECOS PAC ID: 9638272727 Enrollment ID: I20070309000381 |
| Provider Name | Hadi E El Bazouni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477632750 PECOS PAC ID: 3274637509 Enrollment ID: I20070327000272 |
| Provider Name | Erin E Harris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528135852 PECOS PAC ID: 7719082718 Enrollment ID: I20070419000707 |
| Provider Name | Mouna Abouamara |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447324603 PECOS PAC ID: 4587761788 Enrollment ID: I20070523000351 |
| Provider Name | John P Franko |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538238159 PECOS PAC ID: 7618985136 Enrollment ID: I20070707000041 |
| Provider Name | Jeffrey R Looney |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1316942584 PECOS PAC ID: 1355432493 Enrollment ID: I20070803000510 |
| Provider Name | Shari K Rajoo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730149790 PECOS PAC ID: 6305806332 Enrollment ID: I20070815000881 |
| Provider Name | Deana Harmon |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417087768 PECOS PAC ID: 1254424567 Enrollment ID: I20070831000527 |
| Provider Name | Clinton A Musil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366546046 PECOS PAC ID: 6800988320 Enrollment ID: I20070907000373 |
| Provider Name | Brian Edward Ingalls |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477584654 PECOS PAC ID: 2769576685 Enrollment ID: I20070921000514 |
| Provider Name | Ambreen A Warsy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336335835 PECOS PAC ID: 6204922073 Enrollment ID: I20071010000384 |
| Provider Name | Darshan S Shah |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659467678 PECOS PAC ID: 5799869251 Enrollment ID: I20080222000421 |
| Provider Name | Gayatri Bala Jaishankar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1215987607 PECOS PAC ID: 5698859445 Enrollment ID: I20080303000744 |
| Provider Name | Jamie E Givens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871634428 PECOS PAC ID: 8628154044 Enrollment ID: I20080326000451 |
| Provider Name | Steven M Smith |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1699763359 PECOS PAC ID: 5496832453 Enrollment ID: I20080402000060 |
| Provider Name | J Suzanne Moore |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1558533760 PECOS PAC ID: 5890873517 Enrollment ID: I20080422000386 |
| Provider Name | John S Culp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801885850 PECOS PAC ID: 1557431731 Enrollment ID: I20080530000117 |
| Provider Name | Melania Bochis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083607329 PECOS PAC ID: 0446320675 Enrollment ID: I20080530000572 |
| Provider Name | Reid B Blackwelder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942260112 PECOS PAC ID: 3375613482 Enrollment ID: I20080602000356 |
| Provider Name | Des R Bharti |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932192275 PECOS PAC ID: 3779653829 Enrollment ID: I20080602000745 |
| Provider Name | Beth A Fox |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225014483 PECOS PAC ID: 8729158878 Enrollment ID: I20080602000803 |
| Provider Name | David R Ginn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669465662 PECOS PAC ID: 7214007269 Enrollment ID: I20080602000873 |
| Provider Name | Rajani Anand |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1821081134 PECOS PAC ID: 0840360855 Enrollment ID: I20080603000398 |
| Provider Name | James D Holt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104802909 PECOS PAC ID: 7719057736 Enrollment ID: I20080603000535 |
| Provider Name | William M Devoe |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1801889092 PECOS PAC ID: 8325118359 Enrollment ID: I20080603000567 |
| Provider Name | Jason E Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447236450 PECOS PAC ID: 6709784937 Enrollment ID: I20080603000568 |
| Provider Name | Michael P Kauzlarich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477539542 PECOS PAC ID: 0042380073 Enrollment ID: I20080603000581 |
| Provider Name | Max M Bayard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588653521 PECOS PAC ID: 2466522404 Enrollment ID: I20080603000714 |
| Provider Name | Martin E Olsen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1003801929 PECOS PAC ID: 9133299068 Enrollment ID: I20080604000631 |
| Provider Name | Diana L Nunley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215922133 PECOS PAC ID: 4880764612 Enrollment ID: I20080604000705 |
| Provider Name | Stuart S Leicht |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1013902907 PECOS PAC ID: 2769552561 Enrollment ID: I20080605000539 |
| Provider Name | Kenneth E Olive |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487649307 PECOS PAC ID: 5496825200 Enrollment ID: I20080605000647 |
| Provider Name | Jonathan F Moorman |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1023003936 PECOS PAC ID: 3173693991 Enrollment ID: I20080605000779 |
| Provider Name | Debra Q Mills |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467447367 PECOS PAC ID: 8123198843 Enrollment ID: I20080605000840 |
| Provider Name | Olga Sarkodie |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1396939955 PECOS PAC ID: 5395819874 Enrollment ID: I20080731000613 |
| Provider Name | Demetrio Macariola |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093812489 PECOS PAC ID: 7214002948 Enrollment ID: I20080814000707 |
| Provider Name | Angela G Willocks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033177092 PECOS PAC ID: 7315012341 Enrollment ID: I20080826000411 |
| Provider Name | Amanda M Stoltz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427243278 PECOS PAC ID: 8123194024 Enrollment ID: I20080828000553 |
| Provider Name | Natalie Duncan Scott |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1184819161 PECOS PAC ID: 6406922509 Enrollment ID: I20080912000418 |
| Provider Name | Mark Kenneth Brummel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477619872 PECOS PAC ID: 7416056486 Enrollment ID: I20080920000158 |
| Provider Name | Marcela I Popescu |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1982666533 PECOS PAC ID: 5092816421 Enrollment ID: I20090407000462 |
| Provider Name | Julie L Hunt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083852156 PECOS PAC ID: 7517016181 Enrollment ID: I20090601000584 |
| Provider Name | Ryan J Chatelain |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1275708778 PECOS PAC ID: 3870664675 Enrollment ID: I20090702000531 |
| Provider Name | Arthur R Garrett |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1124045646 PECOS PAC ID: 1254483944 Enrollment ID: I20090709000666 |
| Provider Name | Heather Champney |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912174657 PECOS PAC ID: 9830241355 Enrollment ID: I20090714000799 |
| Provider Name | Martha A Bird |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417138512 PECOS PAC ID: 2163512237 Enrollment ID: I20090804000854 |
| Provider Name | Roland K Huffaker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1881608693 PECOS PAC ID: 4981603529 Enrollment ID: I20090806000819 |
| Provider Name | Harold J Webb |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1548291859 PECOS PAC ID: 9931116431 Enrollment ID: I20090817000752 |
| Provider Name | Thomas W Jernigan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1528063245 PECOS PAC ID: 1557417052 Enrollment ID: I20090925000021 |
| Provider Name | Brent D Laing |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1700991049 PECOS PAC ID: 1557468105 Enrollment ID: I20090929000229 |
| Provider Name | John D Green |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1659486900 PECOS PAC ID: 4183721731 Enrollment ID: I20090929000244 |
| Provider Name | Otto H Teixeira |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831184266 PECOS PAC ID: 1153491618 Enrollment ID: I20091202000436 |
| Provider Name | Anne H Eberhart |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1831182948 PECOS PAC ID: 8426185976 Enrollment ID: I20100415000179 |
| Provider Name | Daniel S Rush |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1396732798 PECOS PAC ID: 9931236494 Enrollment ID: I20100415000233 |
| Provider Name | Carols A Floresguerra |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1548253610 PECOS PAC ID: 1658408117 Enrollment ID: I20100415000252 |
| Provider Name | Nancy Juduan Alison |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1679566962 PECOS PAC ID: 2163551854 Enrollment ID: I20100518000363 |
| Provider Name | Jodi B Gage |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1083619118 PECOS PAC ID: 7214067354 Enrollment ID: I20100616000181 |
| Provider Name | Randy W Hoover |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255336434 PECOS PAC ID: 7012041619 Enrollment ID: I20100818000714 |
| Provider Name | Janet Brown |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1619960887 PECOS PAC ID: 9830213966 Enrollment ID: I20100826000553 |
| Provider Name | David Paul Russell |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1801845862 PECOS PAC ID: 3375735145 Enrollment ID: I20101012000634 |
| Provider Name | Lamis W. Ibrahim |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1780872358 PECOS PAC ID: 9537352117 Enrollment ID: I20101015000736 |
| Provider Name | Kamran Hayel-moghadam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437344595 PECOS PAC ID: 2567656077 Enrollment ID: I20101028001054 |
| Provider Name | Jack S Goldstein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457443228 PECOS PAC ID: 9133187016 Enrollment ID: I20101115000698 |
| Provider Name | Zhi Q Yao |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1285813741 PECOS PAC ID: 1456546555 Enrollment ID: I20101115001224 |
| Provider Name | Vijay K. Ramu |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1164519104 PECOS PAC ID: 8426244971 Enrollment ID: I20101123000084 |
| Provider Name | William A Mccormick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740411313 PECOS PAC ID: 6800072687 Enrollment ID: I20110511000589 |
| Provider Name | Dima Youssef |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1245411255 PECOS PAC ID: 2163600594 Enrollment ID: I20110706000496 |
| Provider Name | Ariel Spencer |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1144437518 PECOS PAC ID: 6204994700 Enrollment ID: I20110715000114 |
| Provider Name | Emmalea Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073891701 PECOS PAC ID: 1759550478 Enrollment ID: I20110812000514 |
| Provider Name | Elizabeth G Humston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154581445 PECOS PAC ID: 3476723792 Enrollment ID: I20110824000406 |
| Provider Name | Dianna Cooley Puhr |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700077369 PECOS PAC ID: 0244402527 Enrollment ID: I20111010000356 |
| Provider Name | Remigiusz M Switalski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881859882 PECOS PAC ID: 4486826492 Enrollment ID: I20111018000341 |
| Provider Name | Jennifer Diane Gibson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1811125057 PECOS PAC ID: 0042475956 Enrollment ID: I20120627000306 |
| Provider Name | Timir Kumar Paul |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1336337195 PECOS PAC ID: 7012172521 Enrollment ID: I20120709000401 |
| Provider Name | Jesse D. Gilreath |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720347081 PECOS PAC ID: 9739344995 Enrollment ID: I20120713000307 |
| Provider Name | Ali Rafai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558504704 PECOS PAC ID: 1557527421 Enrollment ID: I20120720000269 |
| Provider Name | Deidre Pierce |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386819407 PECOS PAC ID: 0547426421 Enrollment ID: I20120720000289 |
| Provider Name | Rebecca P Wilkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467691857 PECOS PAC ID: 9638328628 Enrollment ID: I20121008000376 |
| Provider Name | John W Schweitzer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033473392 PECOS PAC ID: 7618127242 Enrollment ID: I20121017000320 |
| Provider Name | Rupal D. Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487895447 PECOS PAC ID: 2860644804 Enrollment ID: I20121220000258 |
| Provider Name | Terri L Ponder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679812895 PECOS PAC ID: 0446495246 Enrollment ID: I20130327000428 |
| Provider Name | Saravanan Elangovan |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1760595276 PECOS PAC ID: 5597756528 Enrollment ID: I20130617000691 |
| Provider Name | Lindsay A Greer |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1427303007 PECOS PAC ID: 1759520026 Enrollment ID: I20130617000696 |
| Provider Name | Sulleman Malik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699905778 PECOS PAC ID: 9638319692 Enrollment ID: I20130716000194 |
| Provider Name | Victoria Shankle |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568787075 PECOS PAC ID: 8022259746 Enrollment ID: I20130723000522 |
| Provider Name | Marie Johnson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1841546850 PECOS PAC ID: 8729220538 Enrollment ID: I20130807000507 |
| Provider Name | Travis Groth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528351657 PECOS PAC ID: 6709028442 Enrollment ID: I20130809000259 |
| Provider Name | Jacalyn P Gilbert-green |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801107545 PECOS PAC ID: 5092957514 Enrollment ID: I20130813000849 |
| Provider Name | Leigh D Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093917486 PECOS PAC ID: 5496914798 Enrollment ID: I20131002000337 |
| Provider Name | Neha Barakam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942430111 PECOS PAC ID: 2163677923 Enrollment ID: I20131017000647 |
| Provider Name | Meeradevi Sudarsanan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407282098 PECOS PAC ID: 2264667229 Enrollment ID: I20131028001742 |
| Provider Name | Tamra S Mckenzie |
|---|---|
| Provider Type | Practitioner - Surgical Oncology |
| Provider Identifiers | NPI Number: 1245410547 PECOS PAC ID: 5496931636 Enrollment ID: I20131101000989 |
| Provider Name | Dawn M Nuckolls |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508120908 PECOS PAC ID: 7113154345 Enrollment ID: I20131216000595 |
| Provider Name | Stephen A Geraci |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1629096904 PECOS PAC ID: 1951442706 Enrollment ID: I20140305001342 |
| Provider Name | Steven Jay Lavine |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1801863469 PECOS PAC ID: 6406877679 Enrollment ID: I20140408000418 |
| Provider Name | Robert Taylor Means |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003830746 PECOS PAC ID: 1850364977 Enrollment ID: I20140429001288 |
| Provider Name | Roxanne F Underwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982033163 PECOS PAC ID: 1951534825 Enrollment ID: I20140429001989 |
| Provider Name | Schuyler K Geller |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1972653152 PECOS PAC ID: 9234363466 Enrollment ID: I20140710001251 |
| Provider Name | Anna Sue Vaneaton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891129003 PECOS PAC ID: 2860627536 Enrollment ID: I20140804001124 |
| Provider Name | Jeremiah L Marsh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1104141944 PECOS PAC ID: 1759525082 Enrollment ID: I20140923001201 |
| Provider Name | Emily M Pate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801203690 PECOS PAC ID: 8729208418 Enrollment ID: I20140930003088 |
| Provider Name | Shannon B Bramlette |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1316906647 PECOS PAC ID: 2567564909 Enrollment ID: I20141107000326 |
| Provider Name | Shambhavi Chandraiah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760439392 PECOS PAC ID: 8921197914 Enrollment ID: I20141209001308 |
| Provider Name | Sarah G Mccray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114174505 PECOS PAC ID: 5193047736 Enrollment ID: I20141209002077 |
| Provider Name | Mark Xavier Ransom |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1487686598 PECOS PAC ID: 5698992600 Enrollment ID: I20150306000742 |
| Provider Name | David Wood |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912976150 PECOS PAC ID: 3870675069 Enrollment ID: I20150420001763 |
| Provider Name | Alexandra Ashley Nelson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699186866 PECOS PAC ID: 1951629914 Enrollment ID: I20150423001042 |
| Provider Name | Kristy S Eisenzopf |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1205154986 PECOS PAC ID: 5991024937 Enrollment ID: I20150424001586 |
| Provider Name | Michelle L Arwood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124142880 PECOS PAC ID: 8628397502 Enrollment ID: I20150427000543 |
| Provider Name | Patricia Amadio |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568461382 PECOS PAC ID: 1052632577 Enrollment ID: I20150609000414 |
| Provider Name | Debalina Das |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639456866 PECOS PAC ID: 0446562730 Enrollment ID: I20150629002125 |
| Provider Name | Amy Whittlesey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487903654 PECOS PAC ID: 3375776388 Enrollment ID: I20150629002159 |
| Provider Name | Anna Justice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194119404 PECOS PAC ID: 7214249507 Enrollment ID: I20150629002293 |
| Provider Name | Laurie Webb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740328012 PECOS PAC ID: 4789996828 Enrollment ID: I20150702001398 |
| Provider Name | Samantha J Herriott |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1477845444 PECOS PAC ID: 3779803739 Enrollment ID: I20150805009178 |
| Provider Name | Kari Goan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669747184 PECOS PAC ID: 9234445222 Enrollment ID: I20150908000403 |
| Provider Name | Dan Nicolau |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992098396 PECOS PAC ID: 4082921358 Enrollment ID: I20150918000902 |
| Provider Name | Andrew Wilt |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1902168537 PECOS PAC ID: 1456509314 Enrollment ID: I20151105001542 |
| Provider Name | William S Dodd |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134415698 PECOS PAC ID: 1355654880 Enrollment ID: I20151116001439 |
| Provider Name | Martin E Litman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689938052 PECOS PAC ID: 2769782309 Enrollment ID: I20151203001366 |
| Provider Name | Kent Hjerpe |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669477022 PECOS PAC ID: 7416932587 Enrollment ID: I20160308001292 |
| Provider Name | Kevin C Visconti |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1821225327 PECOS PAC ID: 4789810565 Enrollment ID: I20160419001517 |
| Provider Name | Racine Edwards-silva |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912934472 PECOS PAC ID: 9133223837 Enrollment ID: I20160822001141 |
| Provider Name | Brock T Mitchell |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1790121267 PECOS PAC ID: 9335383025 Enrollment ID: I20160822002107 |
| Provider Name | Rochelle Holtzclaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356794713 PECOS PAC ID: 8921393406 Enrollment ID: I20160823001210 |
| Provider Name | Tenessa A Munal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114472883 PECOS PAC ID: 0547555617 Enrollment ID: I20160829001360 |
| Provider Name | Joshua Henry |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1326274929 PECOS PAC ID: 5294983391 Enrollment ID: I20160907000683 |
| Provider Name | William B Buselmeier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548608375 PECOS PAC ID: 6800012188 Enrollment ID: I20160912001236 |
| Provider Name | April H Morrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548718752 PECOS PAC ID: 4789972787 Enrollment ID: I20161006001487 |
| Provider Name | Charity Helton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003367517 PECOS PAC ID: 5395024855 Enrollment ID: I20161128001641 |
| Provider Name | Savannah P Taylor |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1235599580 PECOS PAC ID: 4385924760 Enrollment ID: I20161130001245 |
| Provider Name | Steven F Kendell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295763795 PECOS PAC ID: 4082515044 Enrollment ID: I20170103000226 |
| Provider Name | Deepika Reddy Nallala |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1851609739 PECOS PAC ID: 3971740572 Enrollment ID: I20170105001396 |
| Provider Name | Melissa Dunavant Robinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356761241 PECOS PAC ID: 8224327796 Enrollment ID: I20170207002722 |
| Provider Name | Christopher L Garner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083000780 PECOS PAC ID: 3173807559 Enrollment ID: I20170302001615 |
| Provider Name | Victoria Ashley Pritchett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992244115 PECOS PAC ID: 4880970896 Enrollment ID: I20170405001866 |
| Provider Name | Jennifer Stire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912438706 PECOS PAC ID: 2365729753 Enrollment ID: I20170512001617 |
| Provider Name | Christopher T Cook |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306264668 PECOS PAC ID: 1355618828 Enrollment ID: I20170605001760 |
| Provider Name | Courtney M Andrews |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1881087823 PECOS PAC ID: 9537438163 Enrollment ID: I20170712003935 |
| Provider Name | Carrie N Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558618371 PECOS PAC ID: 0244462257 Enrollment ID: I20170731002096 |
| Provider Name | Amber Coomer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326296674 PECOS PAC ID: 1052682937 Enrollment ID: I20170810003302 |
| Provider Name | Kimberely Walters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144287517 PECOS PAC ID: 2365714946 Enrollment ID: I20170816002394 |
| Provider Name | Bethany L Reynolds |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326486366 PECOS PAC ID: 0941599161 Enrollment ID: I20170829003696 |
| Provider Name | Sara Mills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538699319 PECOS PAC ID: 7012282122 Enrollment ID: I20170928003749 |
| Provider Name | Abigail Cruz |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1407116130 PECOS PAC ID: 1052687209 Enrollment ID: I20171017000255 |
| Provider Name | Luis Isaza |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386842672 PECOS PAC ID: 9133495591 Enrollment ID: I20171030003327 |
| Provider Name | Michael Bourassa |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1013214816 PECOS PAC ID: 9436332129 Enrollment ID: I20171115001575 |
| Provider Name | John Hendrick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508889460 PECOS PAC ID: 9739446600 Enrollment ID: I20171130002261 |
| Provider Name | Hana El Ado Mikdachi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1689962839 PECOS PAC ID: 9537485016 Enrollment ID: I20171204000449 |
| Provider Name | Robert David Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497283402 PECOS PAC ID: 3476811449 Enrollment ID: I20171220001860 |
| Provider Name | Michelle Eileen Johnson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1639324841 PECOS PAC ID: 0345509667 Enrollment ID: I20180112001470 |
| Provider Name | Robert Matthew Tolliver |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285043810 PECOS PAC ID: 0648530188 Enrollment ID: I20180201001771 |
| Provider Name | Paige Noel Mullins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831554575 PECOS PAC ID: 3476817404 Enrollment ID: I20180427001829 |
| Provider Name | Amanda Minick |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063429462 PECOS PAC ID: 0648534230 Enrollment ID: I20180507002830 |
| Provider Name | Michael Ostapchuk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972554822 PECOS PAC ID: 0244389922 Enrollment ID: I20180524002810 |
| Provider Name | Janet Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023549151 PECOS PAC ID: 9032474457 Enrollment ID: I20180605002043 |
| Provider Name | Ashley Nicole Blevins |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1457694929 PECOS PAC ID: 5294082640 Enrollment ID: I20180717002728 |
| Provider Name | Donald Clinton Willis |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1902870611 PECOS PAC ID: 9133243066 Enrollment ID: I20180803001110 |
| Provider Name | Heather M Newman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699014068 PECOS PAC ID: 4587913785 Enrollment ID: I20180821003814 |
| Provider Name | Varun Kumar |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1528567393 PECOS PAC ID: 0840216552 Enrollment ID: I20180822003508 |
| Provider Name | Blair Rose Abelson Reece |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518227719 PECOS PAC ID: 6406080043 Enrollment ID: I20180905001455 |
| Provider Name | Rekha Kadam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740719848 PECOS PAC ID: 5294086047 Enrollment ID: I20180918003727 |
| Provider Name | Amy Leigh Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386155331 PECOS PAC ID: 7416208913 Enrollment ID: I20180921002964 |
| Provider Name | Jennifer Treece |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417391285 PECOS PAC ID: 3577815141 Enrollment ID: I20181009002689 |
| Provider Name | Jason V Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649796251 PECOS PAC ID: 5890047484 Enrollment ID: I20181009003354 |
| Provider Name | Andrea Lynne Hopkins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033506183 PECOS PAC ID: 2163774258 Enrollment ID: I20181018001098 |
| Provider Name | Sarah N. Hewitt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891109930 PECOS PAC ID: 4082932322 Enrollment ID: I20181115001169 |
| Provider Name | Matthew R. Krolikowski |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1215372578 PECOS PAC ID: 0042507915 Enrollment ID: I20181126003868 |
| Provider Name | Jessica Elizabeth Murphy |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1801158282 PECOS PAC ID: 1254626823 Enrollment ID: I20181201000430 |
| Provider Name | Marcy K Lau |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1417298969 PECOS PAC ID: 7012154644 Enrollment ID: I20181213000688 |
| Provider Name | Laurie A Stone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285954404 PECOS PAC ID: 1658568647 Enrollment ID: I20181213000982 |
| Provider Name | Laura Helmly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376939207 PECOS PAC ID: 2466742523 Enrollment ID: I20181219000368 |
| Provider Name | Christopher T Bridges |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588050538 PECOS PAC ID: 1254620016 Enrollment ID: I20190115002384 |
| Provider Name | Joyce A Troxler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093753998 PECOS PAC ID: 2264595081 Enrollment ID: I20190125003096 |
| Provider Name | Steven Ruiz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780098566 PECOS PAC ID: 8325314693 Enrollment ID: I20190208002040 |
| Provider Name | Alison Grace Cronin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1750792891 PECOS PAC ID: 1355689621 Enrollment ID: I20190212000633 |
| Provider Name | Benjamin Daniel Whitfield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114468444 PECOS PAC ID: 9739451410 Enrollment ID: I20190304002460 |
| Provider Name | Mary C Axelrad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003278672 PECOS PAC ID: 9931441441 Enrollment ID: I20190502003023 |
| Provider Name | Renee Miranda |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154740454 PECOS PAC ID: 0143599001 Enrollment ID: I20190503002492 |
| Provider Name | Kristy M Borum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659835429 PECOS PAC ID: 7012250046 Enrollment ID: I20190515000907 |
| Provider Name | Brent E. Aebi |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1902291859 PECOS PAC ID: 3870806631 Enrollment ID: I20190530002513 |
| Provider Name | Jennifer L Quillen |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1396294245 PECOS PAC ID: 4789918715 Enrollment ID: I20190625004027 |
| Provider Name | Ligia Maria Alfaro Cruz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174964803 PECOS PAC ID: 9931435435 Enrollment ID: I20190722001681 |
| Provider Name | Haley Akin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1760878524 PECOS PAC ID: 7618264094 Enrollment ID: I20190724002122 |
| Provider Name | Sara J Mcveigh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669034237 PECOS PAC ID: 1850627142 Enrollment ID: I20190724002252 |
| Provider Name | Lauren Selzer |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1417302613 PECOS PAC ID: 8224365432 Enrollment ID: I20190812000830 |
| Provider Name | Venkata Vedantam |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1255781712 PECOS PAC ID: 5890022016 Enrollment ID: I20190812001573 |
| Provider Name | Rachel Michelle Lindsey |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1922453190 PECOS PAC ID: 8224365226 Enrollment ID: I20190814001606 |
| Provider Name | Lauren N Swift |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1609261197 PECOS PAC ID: 6305194358 Enrollment ID: I20190829000663 |
| Provider Name | Riwaaj Lamsal |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992182091 PECOS PAC ID: 7618251935 Enrollment ID: I20190904003380 |
| Provider Name | Timothy Brad Wood |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1902285000 PECOS PAC ID: 9638408917 Enrollment ID: I20190911003229 |
| Provider Name | Kelly Kahle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346601259 PECOS PAC ID: 2062762529 Enrollment ID: I20190925003892 |
| Provider Name | Whitney D. Krolikowski |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1780099937 PECOS PAC ID: 3476885930 Enrollment ID: I20191101001554 |
| Provider Name | Brittnea Jean Adcock |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396188546 PECOS PAC ID: 5395047765 Enrollment ID: I20191101001854 |
| Provider Name | Timothy Patrick Canavan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1407866296 PECOS PAC ID: 8729002415 Enrollment ID: I20191115000200 |
| Provider Name | Jennifer Leigh Carver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871066738 PECOS PAC ID: 8921435546 Enrollment ID: I20200220001784 |
| Provider Name | Aimee M Barton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750397972 PECOS PAC ID: 8820097462 Enrollment ID: I20200225001890 |
| Provider Name | Telena Mullins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457846040 PECOS PAC ID: 3476809005 Enrollment ID: I20200304000541 |
| Provider Name | Stefanie Petra Yoon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447781018 PECOS PAC ID: 1153759584 Enrollment ID: I20200319000181 |
| Provider Name | Laken A Schang |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881109940 PECOS PAC ID: 6709128929 Enrollment ID: I20200506002895 |
| Provider Name | Bhavesh Arvindbhai Gajjar |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1497903447 PECOS PAC ID: 6709057672 Enrollment ID: I20200511001678 |
| Provider Name | Myesa Haji Emberesh |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1306251269 PECOS PAC ID: 9739510595 Enrollment ID: I20200511002422 |
| Provider Name | Brian Earley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972522803 PECOS PAC ID: 9335100601 Enrollment ID: I20200519003245 |
| Provider Name | Michelle J Waters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285267369 PECOS PAC ID: 4082035662 Enrollment ID: I20200608001197 |
| Provider Name | Regina A Dance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740781483 PECOS PAC ID: 1658701479 Enrollment ID: I20200615000859 |
| Provider Name | Manar H Jbara |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1912325242 PECOS PAC ID: 3779905799 Enrollment ID: I20200622000560 |
| Provider Name | Nevi K Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104269554 PECOS PAC ID: 8628366168 Enrollment ID: I20200702001254 |
| Provider Name | Brad Allen Feltis |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1437110004 PECOS PAC ID: 4082637434 Enrollment ID: I20200810000537 |
| Provider Name | Jeetendra Patel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1255412094 PECOS PAC ID: 2769534171 Enrollment ID: I20200825002269 |
| Provider Name | Patricia L Chambers |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053349159 PECOS PAC ID: 5092779165 Enrollment ID: I20200828002832 |
| Provider Name | Ashley Blaske |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1427314616 PECOS PAC ID: 5294038568 Enrollment ID: I20200831000062 |
| Provider Name | Angela Brooke Harless |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962020750 PECOS PAC ID: 2365869369 Enrollment ID: I20200903003380 |
| Provider Name | Alicia Rose Marie Billington |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1346669041 PECOS PAC ID: 8224457601 Enrollment ID: I20201005000901 |
| Provider Name | Emily L Grieshaber |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1710448568 PECOS PAC ID: 7719307537 Enrollment ID: I20201016001780 |
| Provider Name | Gregory Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245765239 PECOS PAC ID: 4183953607 Enrollment ID: I20201116001188 |
| Provider Name | Trevy Ramos |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1881952067 PECOS PAC ID: 4284982240 Enrollment ID: I20201202000172 |
| Provider Name | Frankie Tidwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316562549 PECOS PAC ID: 8325451529 Enrollment ID: I20210107001624 |
| Provider Name | Thomas Kincer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114994357 PECOS PAC ID: 5890810493 Enrollment ID: I20210217000698 |
| Provider Name | Shannon Hansen Cook |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356502389 PECOS PAC ID: 3173932233 Enrollment ID: I20210503001374 |
| Provider Name | John Hershman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1801058581 PECOS PAC ID: 6406094119 Enrollment ID: I20210615000018 |
| Provider Name | Marcia Laness Wilson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780031534 PECOS PAC ID: 9335476571 Enrollment ID: I20210623004147 |
| Provider Name | Jeremy Powers |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1518387588 PECOS PAC ID: 2567686660 Enrollment ID: I20210629001691 |
| Provider Name | Elizabeth White |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588152292 PECOS PAC ID: 5597166439 Enrollment ID: I20210629001991 |
| Provider Name | Vinendra Gupta |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1629020599 PECOS PAC ID: 6901037621 Enrollment ID: I20210706000214 |
| Provider Name | Priya Jain |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053555433 PECOS PAC ID: 8325299910 Enrollment ID: I20210713001359 |
| Provider Name | Craig Wassinger |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1235357963 PECOS PAC ID: 4587066352 Enrollment ID: I20210715003479 |
| Provider Name | Tara Vick |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1205851383 PECOS PAC ID: 5597857375 Enrollment ID: I20210719000213 |
| Provider Name | Kelsey Lee Lloyd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760970214 PECOS PAC ID: 6507269123 Enrollment ID: I20210720002923 |
| Provider Name | Stephanie Albracht Layne |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184086183 PECOS PAC ID: 0749683191 Enrollment ID: I20210723000416 |
| Provider Name | Ian Matthew Rheault |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1972056729 PECOS PAC ID: 2668876681 Enrollment ID: I20210812000761 |
| Provider Name | Sukhvir Singh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1013406479 PECOS PAC ID: 7416352950 Enrollment ID: I20210823001141 |
| Provider Name | Alexander Melkonian |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215608484 PECOS PAC ID: 9234527532 Enrollment ID: I20211019000643 |
| Provider Name | Nadia Sabri |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922324797 PECOS PAC ID: 3678707247 Enrollment ID: I20211019001621 |
| Provider Name | Elizabeth Powers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790198851 PECOS PAC ID: 0749546091 Enrollment ID: I20211020002057 |
| Provider Name | Heather P Shelton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467084491 PECOS PAC ID: 9234527458 Enrollment ID: I20211020002812 |
| Provider Name | Crystal Yates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215467741 PECOS PAC ID: 9537438684 Enrollment ID: I20220104002535 |
| Provider Name | Richard George Brewer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588323042 PECOS PAC ID: 0749667673 Enrollment ID: I20220516001888 |
| Provider Name | Mathew Christopher Finniss |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1346773793 PECOS PAC ID: 6002295805 Enrollment ID: I20220624002309 |
| Provider Name | Jack Owens |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609952241 PECOS PAC ID: 5597168427 Enrollment ID: I20220627000956 |
| Provider Name | Karen Ballard |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1215121264 PECOS PAC ID: 4486726254 Enrollment ID: I20220713001568 |
| Provider Name | Caleb C Osborne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467949529 PECOS PAC ID: 6901159607 Enrollment ID: I20220714003307 |
| Provider Name | Neethu Prabhakaran Vedantam |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1154851350 PECOS PAC ID: 8628459153 Enrollment ID: I20220714004173 |
| Provider Name | James Johnston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598253957 PECOS PAC ID: 5799010617 Enrollment ID: I20220715000315 |
| Provider Name | Jessica Holt Turner |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1578882239 PECOS PAC ID: 8426430729 Enrollment ID: I20220803001976 |
| Provider Name | Rachel Grove |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508210519 PECOS PAC ID: 4284961046 Enrollment ID: I20220819000130 |
| Provider Name | Trask A Printz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982167110 PECOS PAC ID: 2264768886 Enrollment ID: I20220902002739 |
| Provider Name | Christopher Galletti |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669030904 PECOS PAC ID: 6305256116 Enrollment ID: I20221003001662 |
| Provider Name | Joel Danisi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972529683 PECOS PAC ID: 7517871197 Enrollment ID: I20221004001590 |
| Provider Name | Brandi Lynn Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235863200 PECOS PAC ID: 3173909470 Enrollment ID: I20221010000943 |
| Provider Name | Morgan Kate Treaster |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1881366557 PECOS PAC ID: 4981070232 Enrollment ID: I20221012001202 |
| Provider Name | Molly Oxford |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043431901 PECOS PAC ID: 6800983438 Enrollment ID: I20221104000484 |
| Provider Name | Alvaro Serrano Russi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1306076039 PECOS PAC ID: 5092983510 Enrollment ID: I20221118002493 |
| Provider Name | Christine Sager |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1952402232 PECOS PAC ID: 0749223345 Enrollment ID: I20221123000396 |
| Provider Name | Samantha Danielle Lyon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487262630 PECOS PAC ID: 6608244611 Enrollment ID: I20221123001147 |
| Provider Name | Joseph T Tucciarone |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295345957 PECOS PAC ID: 0941678908 Enrollment ID: I20221216001660 |
| Provider Name | John G Crabill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467438655 PECOS PAC ID: 1759279763 Enrollment ID: I20221220001263 |
| Provider Name | Aleksandr Fuks |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1346323805 PECOS PAC ID: 3375565807 Enrollment ID: I20230108000004 |
| Provider Name | Megan Elizabeth Mcgowan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1245685866 PECOS PAC ID: 0749575819 Enrollment ID: I20230117003135 |
| Provider Name | Sharlet Gayl Slough |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932118072 PECOS PAC ID: 5597869594 Enrollment ID: I20230214000564 |
| Provider Name | Allison Wehunt Bourassa |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1194165696 PECOS PAC ID: 8729451695 Enrollment ID: I20230224001519 |
| Provider Name | Julia Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457789323 PECOS PAC ID: 5597079954 Enrollment ID: I20230419003210 |
| Provider Name | Venkata Siva Krishna Kumar Pulivarthi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184186793 PECOS PAC ID: 0244696615 Enrollment ID: I20230510002059 |
| Provider Name | Britn'y Leanne Edwards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225599947 PECOS PAC ID: 6305202607 Enrollment ID: I20230511000937 |
| Provider Name | Anna S Mamo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346649183 PECOS PAC ID: 7416271341 Enrollment ID: I20230518001416 |
| Provider Name | Jacqueline Heflin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790368066 PECOS PAC ID: 3870992175 Enrollment ID: I20230523002787 |
| Provider Name | Meghana Srinivas |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922529924 PECOS PAC ID: 0749646248 Enrollment ID: I20230524003701 |
| Provider Name | Brian Quang Le |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1750511556 PECOS PAC ID: 1456590827 Enrollment ID: I20230613001961 |
| Provider Name | Jack Larsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972063444 PECOS PAC ID: 3375878929 Enrollment ID: I20230802003172 |
| Provider Name | Timothy Stanfield |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356839898 PECOS PAC ID: 3971850835 Enrollment ID: I20230808002052 |
| Provider Name | Ashley Brown |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1427679166 PECOS PAC ID: 5698181444 Enrollment ID: I20230808002365 |
| Provider Name | Rachel Marie Witt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124727540 PECOS PAC ID: 7416310933 Enrollment ID: I20230831002095 |
| Provider Name | Jared Rhinehardt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447837513 PECOS PAC ID: 5890197420 Enrollment ID: I20230918002655 |
| Provider Name | Jessica Nichole Jones |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932737681 PECOS PAC ID: 7911351267 Enrollment ID: I20230920003956 |
| Provider Name | Sarah Tolliver |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1619597309 PECOS PAC ID: 6800240722 Enrollment ID: I20230927000462 |
| Provider Name | Kendal Eden |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1245903392 PECOS PAC ID: 4880083245 Enrollment ID: I20231002000325 |
| Provider Name | Rabindra Raj Lamichhane |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1073090015 PECOS PAC ID: 9739534959 Enrollment ID: I20231009000939 |
| Provider Name | Connor Alexander Blanton |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1285418715 PECOS PAC ID: 9032565197 Enrollment ID: I20231025002139 |
| Provider Name | Sarah Elizabeth Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568249027 PECOS PAC ID: 7810343878 Enrollment ID: I20231026002876 |
| Provider Name | Clay Blanchett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205398179 PECOS PAC ID: 7911353883 Enrollment ID: I20231029000040 |
| Provider Name | Martha Hawkins Sherrill |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1710369533 PECOS PAC ID: 0244686053 Enrollment ID: I20231031002299 |
| Provider Name | Donald Huffman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689201691 PECOS PAC ID: 7810312410 Enrollment ID: I20231101002560 |
| Provider Name | Kelly Smoot |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407537533 PECOS PAC ID: 0941657100 Enrollment ID: I20231109000154 |
| Provider Name | Stephanie Shadden Roark |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1639873235 PECOS PAC ID: 0840648705 Enrollment ID: I20231204000079 |
| Provider Name | Zhilong Zhao |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710661707 PECOS PAC ID: 7113379538 Enrollment ID: I20240122000412 |
| Provider Name | Michael David Cavanah |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801310586 PECOS PAC ID: 1254690373 Enrollment ID: I20240430004049 |
| Provider Name | Amanda Nash Baldwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376307801 PECOS PAC ID: 4688014152 Enrollment ID: I20240501000714 |
| Provider Name | James Lucas Hungerford |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780850875 PECOS PAC ID: 6103100656 Enrollment ID: I20240604003373 |
| Provider Name | Paige Erin Mcclear |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063095164 PECOS PAC ID: 3971905472 Enrollment ID: I20240709004032 |
| Provider Name | Andrew C Trecartin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1528352754 PECOS PAC ID: 4486934924 Enrollment ID: I20240728000040 |
| Provider Name | Stacey Cunningham |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699033688 PECOS PAC ID: 8224574082 Enrollment ID: I20240729002388 |
| Provider Name | Kaylan Johnson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1457041501 PECOS PAC ID: 6103366497 Enrollment ID: I20240913000383 |
| Provider Name | Elizabeth Hoffman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1033952502 PECOS PAC ID: 3870034689 Enrollment ID: I20240920000327 |
| Provider Name | Cristina Mcadoo |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1831817253 PECOS PAC ID: 2769914704 Enrollment ID: I20241016001299 |
| Provider Name | Salvatore Paolillo |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588051916 PECOS PAC ID: 2466855648 Enrollment ID: I20241021004349 |
| Provider Name | Maria Johana Zambrano |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1235690538 PECOS PAC ID: 1456775261 Enrollment ID: I20241031001088 |
| Provider Name | Stephanie Purvis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942754858 PECOS PAC ID: 3274829577 Enrollment ID: I20241104003664 |
| Provider Name | Rachel Margret Clingensmith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780349340 PECOS PAC ID: 6002341435 Enrollment ID: I20241122000335 |
| Provider Name | Tander Simberloff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083243083 PECOS PAC ID: 9830519909 Enrollment ID: I20241125002206 |
| Provider Name | Kristen Fowler Riem |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740918796 PECOS PAC ID: 4789110487 Enrollment ID: I20241204003881 |
| Provider Name | Robert Koutsouvelis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386217966 PECOS PAC ID: 8628471505 Enrollment ID: I20241206000096 |
| Provider Name | Morgan Buda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689161663 PECOS PAC ID: 9234494485 Enrollment ID: I20241211001068 |
| Provider Name | Dan Frechtling |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609455567 PECOS PAC ID: 9739589904 Enrollment ID: I20241211003751 |
| Provider Name | Joseph Lillegard |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1346453644 PECOS PAC ID: 6204928351 Enrollment ID: I20241213000749 |
| Provider Name | Corey William Iqbal |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1578533675 PECOS PAC ID: 6608839717 Enrollment ID: I20241231000441 |
| Provider Name | Jennifer Hamlin |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1912606948 PECOS PAC ID: 2062942592 Enrollment ID: I20250212002414 |
| Provider Name | Chase Mussard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760010557 PECOS PAC ID: 6709201148 Enrollment ID: I20250317002303 |
| Provider Name | Joshua Godwin |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1619461167 PECOS PAC ID: 1557606274 Enrollment ID: I20250522002278 |
| Provider Name | Erica Renee Carter |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1639960891 PECOS PAC ID: 0042720708 Enrollment ID: I20250611001688 |
Mcc, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 E Watauga Ave, Johnson City, TN 37601 Phone: 423-722-8446 Fax: 423-722-5674 | |
Medical Education Assistance Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 917 W Walnut St, Johnson City, TN 37604 Phone: 423-439-6464 Fax: 423-439-7118 | |
Wyche & Wyche, M.d., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2406 Susannah St, Johnson City, TN 37601 Phone: 423-282-2542 Fax: 423-282-5447 | |
Imperial Healthcare Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1604 Lamons Ln Ste 230, Johnson City, TN 37604 Phone: 423-930-5168 Fax: 423-328-0193 | |
New Life Chiropractic And Wellness Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 514 E Watauga Ave, Johnson City, TN 37601 Phone: 423-928-4101 | |
Blue Ridge Medical Management Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 N State Of Franklin Rd, Ste 301a, Johnson City, TN 37604 Phone: 423-431-6816 Fax: 423-431-2983 | |
State Of Franklin Healthcare Associates Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2528 Wesley St, Suite 2, Johnson City, TN 37601 Phone: 423-794-2430 Fax: 423-283-9719 |