| Mhs Physician Services | |
|
580 N Washington St Janesville WI 53548-2984 | |
| (608) 741-7630 | |
| (608) 741-6890 |
| Full Name | Mhs Physician Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 580 N Washington St, Janesville, Wisconsin |
| Authorized Official Name and Position | Todd Anderson (VP/CFO) |
| Authorized Official Contact | 8159716752 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mhs Physician Services Po Box 5081 Janesville WI 53547-5081 Ph: (608) 741-7630 | Mhs Physician Services 580 N Washington St Janesville WI 53548-2984 Ph: (608) 741-7630 |
| NPI Number | 1598718603 |
|---|---|
| Provider Enumeration Date | 05/18/2006 |
| Last Update Date | 07/24/2020 |
| Medicare PECOS PAC ID | 7416860440 |
|---|---|
| Medicare Enrollment ID | O20031111000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598718603 | NPI | - | NPPES |
| 32796500 | Medicaid | WI | |
| 5621473 | Other | IL | BCBSIL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 310800 (Wisconsin) | Primary |
| Provider Name | Abby C Von Heimburg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801895545 PECOS PAC ID: 2365347887 Enrollment ID: I20031205000685 |
| Provider Name | Monica E Gavran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326123530 PECOS PAC ID: 3173429958 Enrollment ID: I20031211000495 |
| Provider Name | David F Kavanaugh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437176070 PECOS PAC ID: 8921904871 Enrollment ID: I20031212000171 |
| Provider Name | Ronald M Shenfeld |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568497311 PECOS PAC ID: 9537066774 Enrollment ID: I20031216000850 |
| Provider Name | J Eric D Castro |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316971807 PECOS PAC ID: 7719884527 Enrollment ID: I20031218000215 |
| Provider Name | Shailesh R Virani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891842506 PECOS PAC ID: 0941194450 Enrollment ID: I20040213000217 |
| Provider Name | Sanjay Vasudeo Joag |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174543615 PECOS PAC ID: 1658267885 Enrollment ID: I20040225000402 |
| Provider Name | Luciano Orta |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346353505 PECOS PAC ID: 6507753241 Enrollment ID: I20040228000050 |
| Provider Name | Bikram S Dhillon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396788006 PECOS PAC ID: 8921995200 Enrollment ID: I20040302000294 |
| Provider Name | Thomas E Garrity |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1134105125 PECOS PAC ID: 5294623674 Enrollment ID: I20040308000775 |
| Provider Name | Victor I Garber |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609869163 PECOS PAC ID: 8022908250 Enrollment ID: I20040319000281 |
| Provider Name | James Lauren Woodman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932201555 PECOS PAC ID: 6608868195 Enrollment ID: I20040402000654 |
| Provider Name | Jason Bredenkamp |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780601237 PECOS PAC ID: 1951292168 Enrollment ID: I20040406000549 |
| Provider Name | Vijay Kumar Goyal |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1407966484 PECOS PAC ID: 5496743528 Enrollment ID: I20040505001321 |
| Provider Name | Zubair M Syed |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1609819598 PECOS PAC ID: 7113908997 Enrollment ID: I20040527000278 |
| Provider Name | Viquar M Khan Mundozie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972671923 PECOS PAC ID: 4880670397 Enrollment ID: I20040625000671 |
| Provider Name | Steven M Salisbury |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1679638860 PECOS PAC ID: 4981681228 Enrollment ID: I20040702001179 |
| Provider Name | Tawfik Barakat |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1306895644 PECOS PAC ID: 3476531955 Enrollment ID: I20040712000077 |
| Provider Name | Shahid B Ilahi |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1508867078 PECOS PAC ID: 3870571938 Enrollment ID: I20040713001539 |
| Provider Name | Michael J Strassman |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1114084068 PECOS PAC ID: 2567440894 Enrollment ID: I20040719001166 |
| Provider Name | Patrick F Para |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114979036 PECOS PAC ID: 2567432800 Enrollment ID: I20040726001391 |
| Provider Name | Sonya Naryshkin |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1962560425 PECOS PAC ID: 7416927033 Enrollment ID: I20040729001099 |
| Provider Name | Evelyn L Dawis |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1487736724 PECOS PAC ID: 6002889409 Enrollment ID: I20040813001218 |
| Provider Name | Joseph V Stock |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164462248 PECOS PAC ID: 7719951078 Enrollment ID: I20040823000775 |
| Provider Name | Humberto Lamoutte |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588671812 PECOS PAC ID: 0446224026 Enrollment ID: I20040825000790 |
| Provider Name | Raja Chatterji |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1245246065 PECOS PAC ID: 8628042207 Enrollment ID: I20040825000839 |
| Provider Name | Preeti Vemuri |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1548318488 PECOS PAC ID: 3476528951 Enrollment ID: I20040827001226 |
| Provider Name | Jung M Rhee |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1023031770 PECOS PAC ID: 5496720435 Enrollment ID: I20040901000751 |
| Provider Name | Ranjana Nath |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1982762456 PECOS PAC ID: 4880660471 Enrollment ID: I20040903001219 |
| Provider Name | James H Sullivan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891805081 PECOS PAC ID: 9133197452 Enrollment ID: I20040923000509 |
| Provider Name | Timothy Sharp |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1184979056 PECOS PAC ID: 9739140807 Enrollment ID: I20041021000844 |
| Provider Name | Bruce Brantman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437203528 PECOS PAC ID: 8224090717 Enrollment ID: I20041027000906 |
| Provider Name | Mykola Lisowsky |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1053329839 PECOS PAC ID: 4284692328 Enrollment ID: I20041221000764 |
| Provider Name | Angela E Mack |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1902991078 PECOS PAC ID: 1759331085 Enrollment ID: I20050125000593 |
| Provider Name | Stephen L Merrill |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144246489 PECOS PAC ID: 4587614839 Enrollment ID: I20050125000772 |
| Provider Name | Aisha A Mirza |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689742637 PECOS PAC ID: 6002867413 Enrollment ID: I20050202001020 |
| Provider Name | Kenneth H Segel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063496800 PECOS PAC ID: 0446203384 Enrollment ID: I20050303000445 |
| Provider Name | Robert M Cook |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1356432561 PECOS PAC ID: 4789630823 Enrollment ID: I20050322001088 |
| Provider Name | John C Gaskill |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316058043 PECOS PAC ID: 7113964859 Enrollment ID: I20050413001072 |
| Provider Name | Jeffrey E Chung |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396713590 PECOS PAC ID: 2961476189 Enrollment ID: I20050425000299 |
| Provider Name | Jeffrey S Altman |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1831166958 PECOS PAC ID: 8426090358 Enrollment ID: I20050602000261 |
| Provider Name | Michael J Petersen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1518974153 PECOS PAC ID: 9739154212 Enrollment ID: I20050608000965 |
| Provider Name | Robert J Paresi |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1891902359 PECOS PAC ID: 3173503141 Enrollment ID: I20050614000187 |
| Provider Name | Graziella I Bistriceanu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316911472 PECOS PAC ID: 9638114986 Enrollment ID: I20050627000974 |
| Provider Name | S Ramana Rao |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841732666 PECOS PAC ID: 0840236394 Enrollment ID: I20050712001005 |
| Provider Name | Sandhya Raman Karna |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700936390 PECOS PAC ID: 6305874306 Enrollment ID: I20050801000519 |
| Provider Name | Rick A Chitwood |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609977305 PECOS PAC ID: 9133157159 Enrollment ID: I20050801000705 |
| Provider Name | Leonid Raskin |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1558471748 PECOS PAC ID: 9931138062 Enrollment ID: I20050809001050 |
| Provider Name | David S Lewin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316950223 PECOS PAC ID: 8022048875 Enrollment ID: I20050822000397 |
| Provider Name | Douglas H Bryan |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1285743955 PECOS PAC ID: 9931130739 Enrollment ID: I20050822000867 |
| Provider Name | Paul A Toofan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013989805 PECOS PAC ID: 6204867419 Enrollment ID: I20050827000145 |
| Provider Name | Randy S Wittman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1023165644 PECOS PAC ID: 8628000205 Enrollment ID: I20050902000567 |
| Provider Name | Richard L Persino |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1396806303 PECOS PAC ID: 4688606262 Enrollment ID: I20050902000591 |
| Provider Name | Alan D Johnson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1083605034 PECOS PAC ID: 5496787632 Enrollment ID: I20050909000251 |
| Provider Name | Katherine A Galias |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043230279 PECOS PAC ID: 8527091529 Enrollment ID: I20050912000128 |
| Provider Name | Paul H Dehaan |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1386727790 PECOS PAC ID: 7517990799 Enrollment ID: I20050917000214 |
| Provider Name | Ginny Kamboj |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1053342428 PECOS PAC ID: 7517991474 Enrollment ID: I20050921000306 |
| Provider Name | Yasmin Hussain |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1649288457 PECOS PAC ID: 7416973623 Enrollment ID: I20051018000171 |
| Provider Name | Joseph P Mazzei |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548276991 PECOS PAC ID: 8022917145 Enrollment ID: I20051109000201 |
| Provider Name | Christine C Hepperlen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316017007 PECOS PAC ID: 8527086206 Enrollment ID: I20051110000985 |
| Provider Name | James J Greenberg |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164412136 PECOS PAC ID: 7113946443 Enrollment ID: I20051116000511 |
| Provider Name | Shari L. Schabowski |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477555241 PECOS PAC ID: 9234152968 Enrollment ID: I20060109000975 |
| Provider Name | Bradley M Fideler |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1629153077 PECOS PAC ID: 9436172038 Enrollment ID: I20060110000587 |
| Provider Name | Kevin Alan Leiseberg |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1093827685 PECOS PAC ID: 1658386552 Enrollment ID: I20060214000510 |
| Provider Name | Julie Favia |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1154418697 PECOS PAC ID: 2668487497 Enrollment ID: I20060215000081 |
| Provider Name | Glenn Milos |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285602516 PECOS PAC ID: 0143237511 Enrollment ID: I20060425000676 |
| Provider Name | Gilbert J Cua |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1336193507 PECOS PAC ID: 2264445121 Enrollment ID: I20060718000084 |
| Provider Name | Amy Marie Michalak |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1437196698 PECOS PAC ID: 1052324944 Enrollment ID: I20060718000380 |
| Provider Name | Kashif S Haque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285679704 PECOS PAC ID: 3476566001 Enrollment ID: I20060726000078 |
| Provider Name | Jason Gregory Cundiff |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1053325233 PECOS PAC ID: 4688677123 Enrollment ID: I20060823000025 |
| Provider Name | Nathan M Kakish |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518975309 PECOS PAC ID: 2769486075 Enrollment ID: I20060829000205 |
| Provider Name | Dana I Tarandy |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1629001623 PECOS PAC ID: 7012911142 Enrollment ID: I20060905000060 |
| Provider Name | Ruby Khanna |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1629087226 PECOS PAC ID: 3375547318 Enrollment ID: I20060906000502 |
| Provider Name | Michelle Isacson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760432157 PECOS PAC ID: 3476557166 Enrollment ID: I20060912000258 |
| Provider Name | Pamela K Smekrud |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1649292988 PECOS PAC ID: 7719982057 Enrollment ID: I20060920000412 |
| Provider Name | Machelle M Dopkins |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1750300901 PECOS PAC ID: 2062417314 Enrollment ID: I20060920000447 |
| Provider Name | Baseer M Qazi |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1386654093 PECOS PAC ID: 4789689845 Enrollment ID: I20060922000398 |
| Provider Name | Rajeev Varma |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1073525770 PECOS PAC ID: 9830194760 Enrollment ID: I20060927000072 |
| Provider Name | Kathleen Therese Hegarty |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679689988 PECOS PAC ID: 2264431774 Enrollment ID: I20061211000585 |
| Provider Name | Karenmarie K Meyer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1003811035 PECOS PAC ID: 1759484439 Enrollment ID: I20070319000154 |
| Provider Name | Rodney V Gabbert |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1447263561 PECOS PAC ID: 4486759826 Enrollment ID: I20070413000356 |
| Provider Name | Christine M Sorensen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1659444230 PECOS PAC ID: 9537269840 Enrollment ID: I20070714000200 |
| Provider Name | David E Deutsch |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1326158510 PECOS PAC ID: 0345341574 Enrollment ID: I20070718000483 |
| Provider Name | Azeem S Pasha |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619915147 PECOS PAC ID: 5294828224 Enrollment ID: I20070907000417 |
| Provider Name | Shahariar Hossion Saikh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841380714 PECOS PAC ID: 9537253745 Enrollment ID: I20070919000455 |
| Provider Name | Steven B Deliduka |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1598712937 PECOS PAC ID: 0143299651 Enrollment ID: I20071113000152 |
| Provider Name | Alan S Wagner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497701684 PECOS PAC ID: 8123914868 Enrollment ID: I20080111000024 |
| Provider Name | Camelia E Marian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851451132 PECOS PAC ID: 7719061050 Enrollment ID: I20080226000577 |
| Provider Name | Emily Yi Shen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871779744 PECOS PAC ID: 5395810998 Enrollment ID: I20080815000532 |
| Provider Name | Matthew C Valente |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942469598 PECOS PAC ID: 1557436284 Enrollment ID: I20080815000648 |
| Provider Name | Ejaz A Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518902527 PECOS PAC ID: 5890860910 Enrollment ID: I20080823000047 |
| Provider Name | Roshi Gulati |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922290816 PECOS PAC ID: 7719053461 Enrollment ID: I20080904000445 |
| Provider Name | Hristo Deianov Hristov |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1114103892 PECOS PAC ID: 5092881540 Enrollment ID: I20080905000597 |
| Provider Name | Christal West |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427016856 PECOS PAC ID: 0446312730 Enrollment ID: I20081220000037 |
| Provider Name | Gregory F Zankle |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1205910155 PECOS PAC ID: 0547368946 Enrollment ID: I20090129000307 |
| Provider Name | Neda Moaddeli |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1265699615 PECOS PAC ID: 8123182508 Enrollment ID: I20090129000520 |
| Provider Name | Prafull Chandra Gandhi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841391042 PECOS PAC ID: 6507921459 Enrollment ID: I20090210000452 |
| Provider Name | Robert M Goldman |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1588879571 PECOS PAC ID: 8729144084 Enrollment ID: I20090311000628 |
| Provider Name | Dennis A Silver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780726273 PECOS PAC ID: 9234295528 Enrollment ID: I20090312000101 |
| Provider Name | Benito W Aubergine |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073718169 PECOS PAC ID: 4284781402 Enrollment ID: I20090403000541 |
| Provider Name | My Linn Sawyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679602791 PECOS PAC ID: 5496803157 Enrollment ID: I20090507000098 |
| Provider Name | Ronald James Oconer |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1649473729 PECOS PAC ID: 9739289158 Enrollment ID: I20090618000529 |
| Provider Name | Lila N Inouye |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1992746572 PECOS PAC ID: 9133021645 Enrollment ID: I20090717000539 |
| Provider Name | Meredith K Martin Johnston |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1275783300 PECOS PAC ID: 4082767967 Enrollment ID: I20090727000188 |
| Provider Name | James A Krcik |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1174790463 PECOS PAC ID: 7012061864 Enrollment ID: I20090813000628 |
| Provider Name | Rajesh Balagani |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1477754927 PECOS PAC ID: 0244289395 Enrollment ID: I20090821000324 |
| Provider Name | Craig C Lyon |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1881804847 PECOS PAC ID: 6507910874 Enrollment ID: I20090916000147 |
| Provider Name | Lata M Santa Ines |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871621136 PECOS PAC ID: 6305940586 Enrollment ID: I20091001000699 |
| Provider Name | Maria J Wolff |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1467684613 PECOS PAC ID: 6002952785 Enrollment ID: I20091009000529 |
| Provider Name | Patrick E Phelan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1083771398 PECOS PAC ID: 5597809400 Enrollment ID: I20100216000489 |
| Provider Name | Jeffrey Kershaw |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1770641110 PECOS PAC ID: 7911042700 Enrollment ID: I20100304000357 |
| Provider Name | Marko F Krpan |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1992871347 PECOS PAC ID: 7113052358 Enrollment ID: I20100312000956 |
| Provider Name | Benjamin S Frank |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1871554097 PECOS PAC ID: 7517093461 Enrollment ID: I20100330000623 |
| Provider Name | Carey M Bacalar |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1376549394 PECOS PAC ID: 1254469067 Enrollment ID: I20100514000073 |
| Provider Name | Bibiano C Ronquillo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285791228 PECOS PAC ID: 6103956933 Enrollment ID: I20100604000753 |
| Provider Name | Kim Albright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982629390 PECOS PAC ID: 5294865036 Enrollment ID: I20100604000893 |
| Provider Name | Jeffrey Bagdon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518987528 PECOS PAC ID: 9830235902 Enrollment ID: I20100610000589 |
| Provider Name | Mary T Riggs |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1285799627 PECOS PAC ID: 4880684760 Enrollment ID: I20100612000103 |
| Provider Name | Joseph E Fojtik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801971171 PECOS PAC ID: 8123158250 Enrollment ID: I20100616000045 |
| Provider Name | Ricca Y Zaino |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1558418947 PECOS PAC ID: 5395876726 Enrollment ID: I20100629000879 |
| Provider Name | Anil K Khemani |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1750389953 PECOS PAC ID: 8527076652 Enrollment ID: I20100702000171 |
| Provider Name | Daksha N Mehta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982622346 PECOS PAC ID: 0941331052 Enrollment ID: I20100706000090 |
| Provider Name | Allen R Castillo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396881850 PECOS PAC ID: 6103959374 Enrollment ID: I20100809000916 |
| Provider Name | Kimberly A Chaney |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790987469 PECOS PAC ID: 2961594239 Enrollment ID: I20100812000309 |
| Provider Name | Michelle Y Karney |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1760557987 PECOS PAC ID: 8628101508 Enrollment ID: I20100823001130 |
| Provider Name | Todd Schirmang |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1134347305 PECOS PAC ID: 8123142882 Enrollment ID: I20100901000695 |
| Provider Name | Steven J Merema |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1881900538 PECOS PAC ID: 0143345520 Enrollment ID: I20100909000546 |
| Provider Name | Cullen T Kehoe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013166925 PECOS PAC ID: 5496808289 Enrollment ID: I20100909000660 |
| Provider Name | David A Goodman |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1477610665 PECOS PAC ID: 2163616517 Enrollment ID: I20101029001360 |
| Provider Name | Mabria Loqman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891862678 PECOS PAC ID: 1254320096 Enrollment ID: I20101130000620 |
| Provider Name | Richard O Cook |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1508957705 PECOS PAC ID: 3476536616 Enrollment ID: I20101130001275 |
| Provider Name | Randall S Nemerovski |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1912065491 PECOS PAC ID: 0042270266 Enrollment ID: I20101201000919 |
| Provider Name | Briana N Young |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750532065 PECOS PAC ID: 6800924101 Enrollment ID: I20101216000955 |
| Provider Name | Amarish A Dave |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1891877213 PECOS PAC ID: 5092705962 Enrollment ID: I20101221000531 |
| Provider Name | Krishanthi D Seneviratne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972814267 PECOS PAC ID: 7810176195 Enrollment ID: I20110119001241 |
| Provider Name | Mohsin Ali Khan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174636013 PECOS PAC ID: 0547261828 Enrollment ID: I20110125000693 |
| Provider Name | Jaymin R Shah |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1770670408 PECOS PAC ID: 3173702628 Enrollment ID: I20110128001068 |
| Provider Name | Mark R Dvorak |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1699750661 PECOS PAC ID: 6800924085 Enrollment ID: I20110131000976 |
| Provider Name | Fang Zhu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861792715 PECOS PAC ID: 9133399025 Enrollment ID: I20110901000340 |
| Provider Name | Bruce W Cardone |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699723965 PECOS PAC ID: 4082526314 Enrollment ID: I20111004000726 |
| Provider Name | Angela J Schnobel |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1457561482 PECOS PAC ID: 4385818038 Enrollment ID: I20111116000024 |
| Provider Name | Sharon A Swanson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1326329483 PECOS PAC ID: 5092989244 Enrollment ID: I20111128000186 |
| Provider Name | Geetha P Krishnan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699067132 PECOS PAC ID: 5092980938 Enrollment ID: I20111205000749 |
| Provider Name | Shalini Paturi |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1215191754 PECOS PAC ID: 5698940955 Enrollment ID: I20111214001026 |
| Provider Name | Christopher S Schmidt |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1629193750 PECOS PAC ID: 5193819084 Enrollment ID: I20120109000193 |
| Provider Name | Stephen C Cotton |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1891756888 PECOS PAC ID: 1557521812 Enrollment ID: I20120322000689 |
| 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 | Patricio L Ilada |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679630156 PECOS PAC ID: 4587565338 Enrollment ID: I20120618000644 |
| Provider Name | Nicholas Skyba |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932338050 PECOS PAC ID: 2769647601 Enrollment ID: I20120627000605 |
| Provider Name | Joanne Rousseau |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891936969 PECOS PAC ID: 2961677026 Enrollment ID: I20120718000365 |
| Provider Name | Anastasia Osipova |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1073889382 PECOS PAC ID: 0244496875 Enrollment ID: I20120725000559 |
| Provider Name | Robina M Iqbal |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1760788376 PECOS PAC ID: 0244406155 Enrollment ID: I20120816000637 |
| Provider Name | Shahab Mohiuddin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255568853 PECOS PAC ID: 1850540485 Enrollment ID: I20120925000814 |
| Provider Name | Syed Parvez Quadri |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1417190265 PECOS PAC ID: 7517116676 Enrollment ID: I20121004000412 |
| Provider Name | Shawn S Wallery |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881851780 PECOS PAC ID: 0749430445 Enrollment ID: I20121015000364 |
| Provider Name | Nancy T Barnes |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1184871634 PECOS PAC ID: 8426200510 Enrollment ID: I20121219000187 |
| Provider Name | Kelly M Winkelman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649523838 PECOS PAC ID: 0244484400 Enrollment ID: I20130218000162 |
| Provider Name | Thomas R Stoiber |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548234164 PECOS PAC ID: 0143111708 Enrollment ID: I20130226000254 |
| Provider Name | Yaser Siraj |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1760497416 PECOS PAC ID: 6901800218 Enrollment ID: I20130308000295 |
| Provider Name | Javed I Bangash |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1326090598 PECOS PAC ID: 9234374240 Enrollment ID: I20130322000180 |
| Provider Name | Virginia P Luces |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366494585 PECOS PAC ID: 1951546969 Enrollment ID: I20130322000192 |
| Provider Name | Eric T Miranda |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1730336322 PECOS PAC ID: 8123263639 Enrollment ID: I20130403000270 |
| Provider Name | Laeeq S Shamsuddin |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1568524312 PECOS PAC ID: 0244322360 Enrollment ID: I20130413000027 |
| Provider Name | Rajesh Kakarla |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609026467 PECOS PAC ID: 9335319185 Enrollment ID: I20130517000077 |
| Provider Name | Glendon C Burress |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1639190200 PECOS PAC ID: 0345480810 Enrollment ID: I20130703000425 |
| Provider Name | Kathleen S Schmelka |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114977352 PECOS PAC ID: 8921067778 Enrollment ID: I20130826000791 |
| Provider Name | Syed Hassan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063637544 PECOS PAC ID: 7517013154 Enrollment ID: I20131021001358 |
| Provider Name | Christine Marie Swanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225465305 PECOS PAC ID: 7315174174 Enrollment ID: I20131226001307 |
| Provider Name | Farnaz Almasganj |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1568672160 PECOS PAC ID: 7517195209 Enrollment ID: I20131231000712 |
| Provider Name | Maria Kostantacos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538493614 PECOS PAC ID: 3072749845 Enrollment ID: I20140113000392 |
| Provider Name | Cherise L Cokley |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1285835025 PECOS PAC ID: 7517196843 Enrollment ID: I20140210000082 |
| Provider Name | Baby Than |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033371554 PECOS PAC ID: 9638336878 Enrollment ID: I20140305000076 |
| Provider Name | Christopher L. Wistrom |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700041886 PECOS PAC ID: 2365613221 Enrollment ID: I20140428000631 |
| Provider Name | Erin K Swanson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1538325485 PECOS PAC ID: 7012140536 Enrollment ID: I20140507000562 |
| Provider Name | James P Maletich |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235426826 PECOS PAC ID: 5496984627 Enrollment ID: I20140702000408 |
| Provider Name | Biana Kotlyar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023397668 PECOS PAC ID: 1759520687 Enrollment ID: I20140811002725 |
| Provider Name | Breanna Leah Walker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1174843635 PECOS PAC ID: 6305085937 Enrollment ID: I20140930002307 |
| Provider Name | Susan K Mercado |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1760882542 PECOS PAC ID: 9830310374 Enrollment ID: I20141024002114 |
| Provider Name | Vibhav Bansal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730337569 PECOS PAC ID: 2163680851 Enrollment ID: I20141110002095 |
| Provider Name | Katherine J Horton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013305705 PECOS PAC ID: 1456676592 Enrollment ID: I20150211001759 |
| Provider Name | Emily Kathleen Wilczak |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1386969400 PECOS PAC ID: 3678726544 Enrollment ID: I20150424000402 |
| Provider Name | Jill L Ritzman |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1609263110 PECOS PAC ID: 7911226246 Enrollment ID: I20150512001150 |
| Provider Name | Rajyalakshmi Gannu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770600769 PECOS PAC ID: 8628253754 Enrollment ID: I20150515001651 |
| Provider Name | Jodee B Meddy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699934240 PECOS PAC ID: 6406024926 Enrollment ID: I20150608000817 |
| Provider Name | Karuna Chilukuri |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1497941629 PECOS PAC ID: 6204901630 Enrollment ID: I20150626000366 |
| Provider Name | Maajid M Ekkiswala |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1104110436 PECOS PAC ID: 5890912224 Enrollment ID: I20150723009302 |
| Provider Name | Allyson D Weiss |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1447634472 PECOS PAC ID: 4981917580 Enrollment ID: I20150724010350 |
| Provider Name | Christy D Short |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659699833 PECOS PAC ID: 5799910055 Enrollment ID: I20150805007739 |
| Provider Name | John A Pakiela |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265402036 PECOS PAC ID: 4082684592 Enrollment ID: I20150821013025 |
| Provider Name | Velislava Lozeva |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1831455021 PECOS PAC ID: 9234446691 Enrollment ID: I20150916003572 |
| Provider Name | Robert A Marshall |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1063438570 PECOS PAC ID: 1850604224 Enrollment ID: I20150923002336 |
| Provider Name | John C Heyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750310363 PECOS PAC ID: 0941262265 Enrollment ID: I20151202002437 |
| Provider Name | Roseviminda Abano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215318555 PECOS PAC ID: 9931404530 Enrollment ID: I20160219000022 |
| Provider Name | Lindsey A Keller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871968305 PECOS PAC ID: 8820395791 Enrollment ID: I20160322000327 |
| Provider Name | Norman J. Mecwan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114398930 PECOS PAC ID: 9537466909 Enrollment ID: I20160330000730 |
| Provider Name | Rotimi Osahon Johnson |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1144537051 PECOS PAC ID: 8628226016 Enrollment ID: I20160408000763 |
| Provider Name | Kelli M Danowski |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1508155300 PECOS PAC ID: 1254582125 Enrollment ID: I20160422001643 |
| Provider Name | Nicholas K Ventocilla |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1164876967 PECOS PAC ID: 1759680408 Enrollment ID: I20160502000083 |
| Provider Name | Jakob C Thorud |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1174818272 PECOS PAC ID: 8729207691 Enrollment ID: I20160505001953 |
| Provider Name | Bilal A Ahmed |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568487650 PECOS PAC ID: 5092728592 Enrollment ID: I20160517001363 |
| Provider Name | Mohammad A Ishaq |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336585140 PECOS PAC ID: 6406157684 Enrollment ID: I20160718000381 |
| Provider Name | Matthew E Smetana |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487093795 PECOS PAC ID: 4284955139 Enrollment ID: I20160801002071 |
| Provider Name | Saba Chaudhry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194099036 PECOS PAC ID: 9335463967 Enrollment ID: I20160804001216 |
| Provider Name | Roseann C Iverson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386099208 PECOS PAC ID: 0547554578 Enrollment ID: I20160812001834 |
| Provider Name | Syed A Masood |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1548471204 PECOS PAC ID: 0840367843 Enrollment ID: I20160815002846 |
| Provider Name | Brenda L Garrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417209768 PECOS PAC ID: 5496040438 Enrollment ID: I20160830000599 |
| Provider Name | Paul Bennett Lewis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477710424 PECOS PAC ID: 0446560056 Enrollment ID: I20160831002783 |
| Provider Name | Joan K Zawin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205912037 PECOS PAC ID: 9739171109 Enrollment ID: I20161012001580 |
| Provider Name | Mary Elizabeth Agulo |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1225581408 PECOS PAC ID: 9638457039 Enrollment ID: I20161104000873 |
| Provider Name | Aapti Patel |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114479748 PECOS PAC ID: 8022398775 Enrollment ID: I20161215000117 |
| Provider Name | Jacquelyn V Saengmany |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558803791 PECOS PAC ID: 2567743602 Enrollment ID: I20170103000814 |
| Provider Name | Mary Jo Winkenwerder |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1437522810 PECOS PAC ID: 1557643285 Enrollment ID: I20170112002669 |
| Provider Name | Harigovinda Reddy Challa |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508942319 PECOS PAC ID: 0042288698 Enrollment ID: I20170217001556 |
| Provider Name | Amber L Szydelko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538606488 PECOS PAC ID: 0648554337 Enrollment ID: I20170223002304 |
| Provider Name | Ashley N Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841738606 PECOS PAC ID: 0143505222 Enrollment ID: I20170403001142 |
| Provider Name | Dany Mamou |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679704100 PECOS PAC ID: 2961653092 Enrollment ID: I20170526000586 |
| Provider Name | Kyle E Pfeifer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932494986 PECOS PAC ID: 5496054934 Enrollment ID: I20170605000978 |
| Provider Name | Noman Shahid |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992111009 PECOS PAC ID: 8123349818 Enrollment ID: I20170803000422 |
| Provider Name | Jennifer J Gibson Chambers |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1689017220 PECOS PAC ID: 4789994633 Enrollment ID: I20170807001256 |
| Provider Name | Huda Arif |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063852481 PECOS PAC ID: 2264726967 Enrollment ID: I20170831000015 |
| Provider Name | Christopher W Grant |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114212040 PECOS PAC ID: 9931409265 Enrollment ID: I20170908001565 |
| Provider Name | Terrance R Grant |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275822090 PECOS PAC ID: 2365715463 Enrollment ID: I20170913000008 |
| Provider Name | Neil P Shah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376821082 PECOS PAC ID: 3274806245 Enrollment ID: I20170913003245 |
| Provider Name | Deborah L Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730615030 PECOS PAC ID: 8820369234 Enrollment ID: I20171025002306 |
| Provider Name | Merrit Marion Debartolo |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1427379189 PECOS PAC ID: 0941595631 Enrollment ID: I20171117001343 |
| Provider Name | Dennis D. Magdadaro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578074753 PECOS PAC ID: 3375800162 Enrollment ID: I20171204001331 |
| Provider Name | Thomas Stephen Olsen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1124423645 PECOS PAC ID: 3870851173 Enrollment ID: I20171214000820 |
| Provider Name | Hamik Biramian |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1689817488 PECOS PAC ID: 8022270503 Enrollment ID: I20171220003370 |
| Provider Name | Robert H Sorensen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1447215702 PECOS PAC ID: 9032121793 Enrollment ID: I20180327001337 |
| Provider Name | Karen Klawitter |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366409393 PECOS PAC ID: 8628330883 Enrollment ID: I20180328000481 |
| Provider Name | Stanley W Welch |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124008339 PECOS PAC ID: 2264425875 Enrollment ID: I20180511002036 |
| Provider Name | Kenneth Laput |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184138042 PECOS PAC ID: 8628339496 Enrollment ID: I20180703000097 |
| Provider Name | Abdoulie Njie |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164836433 PECOS PAC ID: 7517251796 Enrollment ID: I20180719002814 |
| Provider Name | Rhonda R Verzal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760701007 PECOS PAC ID: 7214198605 Enrollment ID: I20180719003239 |
| Provider Name | Carmen A Alcala |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639583560 PECOS PAC ID: 8325343460 Enrollment ID: I20180724000857 |
| Provider Name | Robert Long |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720407430 PECOS PAC ID: 6406144989 Enrollment ID: I20180830000902 |
| Provider Name | Amanda M Mcsweeney |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1124073705 PECOS PAC ID: 5496769978 Enrollment ID: I20181001000758 |
| Provider Name | Maleah J Merline |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1942783071 PECOS PAC ID: 3577815778 Enrollment ID: I20181017001159 |
| Provider Name | Andrew D Tannenbaum |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972867315 PECOS PAC ID: 4981836897 Enrollment ID: I20181017001453 |
| Provider Name | Morgan S Bock |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1265914584 PECOS PAC ID: 9032461942 Enrollment ID: I20181027000214 |
| Provider Name | Sarah R Linder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134603095 PECOS PAC ID: 8820332166 Enrollment ID: I20181127003409 |
| Provider Name | Jennifer R Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750535449 PECOS PAC ID: 0244280279 Enrollment ID: I20181128000320 |
| Provider Name | Donald R Anderson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609090026 PECOS PAC ID: 3577654938 Enrollment ID: I20181128002318 |
| Provider Name | Marita L Verhalen |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1720447675 PECOS PAC ID: 4688919491 Enrollment ID: I20181226001543 |
| Provider Name | Benjamin D Lemoine |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497071872 PECOS PAC ID: 4587963228 Enrollment ID: I20181231001481 |
| Provider Name | Nimarta Singh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073892253 PECOS PAC ID: 0648573915 Enrollment ID: I20190130000883 |
| Provider Name | Brenda Neshell Sims |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407348337 PECOS PAC ID: 0547508814 Enrollment ID: I20190212000605 |
| Provider Name | Anil G Rao |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083657514 PECOS PAC ID: 6305860719 Enrollment ID: I20190225002218 |
| Provider Name | James W Bauer |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1902249543 PECOS PAC ID: 7719242726 Enrollment ID: I20190617000140 |
| Provider Name | Mandy J Rueff |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1649736174 PECOS PAC ID: 3971838947 Enrollment ID: I20190712001346 |
| Provider Name | Moamen Al Zoubi |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1770902587 PECOS PAC ID: 4688978083 Enrollment ID: I20190725000653 |
| Provider Name | Wendy Marie Belletynee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619529138 PECOS PAC ID: 5193051365 Enrollment ID: I20190725001093 |
| Provider Name | Rosario A Carrasco |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720288079 PECOS PAC ID: 7012921869 Enrollment ID: I20190731002034 |
| Provider Name | Shannon R Vokac |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1588229413 PECOS PAC ID: 9436487303 Enrollment ID: I20190830000701 |
| Provider Name | Matthew T Groenwald |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1124461645 PECOS PAC ID: 6709169477 Enrollment ID: I20190906000047 |
| Provider Name | Mohammad Amir |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386036085 PECOS PAC ID: 6204146848 Enrollment ID: I20190910002079 |
| Provider Name | Maria V Gomez |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982087433 PECOS PAC ID: 0941505994 Enrollment ID: I20191004002895 |
| Provider Name | Mitchell L Sheley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093102378 PECOS PAC ID: 5496056160 Enrollment ID: I20191028001195 |
| Provider Name | Rameeza Sheriff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770945222 PECOS PAC ID: 3072888197 Enrollment ID: I20191108000695 |
| Provider Name | Heather M Murnane |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497168355 PECOS PAC ID: 2860824935 Enrollment ID: I20191120000594 |
| Provider Name | Alexander Eric Zajac |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1730508805 PECOS PAC ID: 4486955622 Enrollment ID: I20191120001477 |
| Provider Name | Jennifer C Finch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275193062 PECOS PAC ID: 9638503790 Enrollment ID: I20191223001784 |
| Provider Name | Ather M Ali |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518308246 PECOS PAC ID: 2365763315 Enrollment ID: I20200109001931 |
| Provider Name | Benjamin R Banks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053809285 PECOS PAC ID: 0244560142 Enrollment ID: I20200323000772 |
| Provider Name | Kenyn Lawrence Koop |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124507439 PECOS PAC ID: 1557691987 Enrollment ID: I20200326002015 |
| Provider Name | Taylor Wade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710464482 PECOS PAC ID: 9638406523 Enrollment ID: I20200327000183 |
| Provider Name | Yaser R Mustafa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992217178 PECOS PAC ID: 1355670845 Enrollment ID: I20200327000327 |
| Provider Name | Eli T James |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669959441 PECOS PAC ID: 2163855537 Enrollment ID: I20200330000551 |
| Provider Name | Janet Barkhou |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144752528 PECOS PAC ID: 3678832268 Enrollment ID: I20200330001235 |
| Provider Name | Jason R Moen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588152714 PECOS PAC ID: 8123351590 Enrollment ID: I20200330001287 |
| Provider Name | Muhammad Saleem |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194213272 PECOS PAC ID: 5890030258 Enrollment ID: I20200330001725 |
| Provider Name | Jane E Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942220140 PECOS PAC ID: 3375673122 Enrollment ID: I20200331000098 |
| Provider Name | Marsha Landvatter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053809343 PECOS PAC ID: 9335478288 Enrollment ID: I20200331000173 |
| Provider Name | Saba Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780172064 PECOS PAC ID: 7911230388 Enrollment ID: I20200402000004 |
| Provider Name | Jacob Landvatter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649768938 PECOS PAC ID: 9739413030 Enrollment ID: I20200402002468 |
| Provider Name | Suhail A Shaikh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184808529 PECOS PAC ID: 0143380451 Enrollment ID: I20200417001859 |
| Provider Name | Kelsey Pendleton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497140503 PECOS PAC ID: 3072863646 Enrollment ID: I20200423003508 |
| Provider Name | Imdad Ahmed |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1053536219 PECOS PAC ID: 6305946344 Enrollment ID: I20200626000726 |
| Provider Name | Sean W Marquis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053554089 PECOS PAC ID: 5496921249 Enrollment ID: I20200708000417 |
| Provider Name | Vincent Boston |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134572340 PECOS PAC ID: 1456686740 Enrollment ID: I20200729000398 |
| Provider Name | Jacob G Ginglen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1538518386 PECOS PAC ID: 3779821467 Enrollment ID: I20200729001817 |
| Provider Name | James Robert Tobin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750812145 PECOS PAC ID: 3375814825 Enrollment ID: I20200911000887 |
| Provider Name | Heather Nicole Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023621760 PECOS PAC ID: 1557772761 Enrollment ID: I20201119000669 |
| Provider Name | Jazira B Sultanova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508238221 PECOS PAC ID: 3678874096 Enrollment ID: I20201204000302 |
| Provider Name | Chanthou Vong |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1811348170 PECOS PAC ID: 3375837768 Enrollment ID: I20201223000802 |
| Provider Name | Marwan M Abdulsattar |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1265790695 PECOS PAC ID: 9638468531 Enrollment ID: I20201223001790 |
| Provider Name | Ewald J Horwath |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720128986 PECOS PAC ID: 7113975525 Enrollment ID: I20210305001723 |
| Provider Name | Charles Windham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306058540 PECOS PAC ID: 5799708244 Enrollment ID: I20210308001516 |
| Provider Name | Carlos E Collin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609850171 PECOS PAC ID: 2365487923 Enrollment ID: I20210309000244 |
| Provider Name | Alberto A Penalver |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740294545 PECOS PAC ID: 4183756687 Enrollment ID: I20210309002308 |
| Provider Name | Jonathan Lee Hulkower |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063597961 PECOS PAC ID: 0749323343 Enrollment ID: I20210309002646 |
| Provider Name | Diana L Santiago |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588872287 PECOS PAC ID: 2668597840 Enrollment ID: I20210310002559 |
| Provider Name | Victor Sawhney |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700013802 PECOS PAC ID: 1456584622 Enrollment ID: I20210311001438 |
| Provider Name | Julia Hoang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801202197 PECOS PAC ID: 3375970627 Enrollment ID: I20210312002340 |
| Provider Name | Kara M Sturlini |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275043093 PECOS PAC ID: 1850652348 Enrollment ID: I20210330001968 |
| Provider Name | Mohammed I Azam |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275947392 PECOS PAC ID: 4486920683 Enrollment ID: I20210412000915 |
| Provider Name | Heather Ann Koopmann |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1013596485 PECOS PAC ID: 6103227426 Enrollment ID: I20210624000889 |
| Provider Name | Fares W Sweis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083095814 PECOS PAC ID: 1254644735 Enrollment ID: I20210903001040 |
| Provider Name | Lauren Mount |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487242830 PECOS PAC ID: 9931506987 Enrollment ID: I20210918000058 |
| Provider Name | Myra Khan |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1588075162 PECOS PAC ID: 5991008955 Enrollment ID: I20211101001357 |
| Provider Name | Pamela Maloney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871267997 PECOS PAC ID: 0547650707 Enrollment ID: I20211201002348 |
| Provider Name | Nadeen Z. Sweis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720469539 PECOS PAC ID: 0244543726 Enrollment ID: I20211227000335 |
| Provider Name | John M Mamalakis |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1780726661 PECOS PAC ID: 0749188712 Enrollment ID: I20220107000603 |
| Provider Name | Shail Y Brahmbhatt |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1740948090 PECOS PAC ID: 1557752730 Enrollment ID: I20220131000515 |
| Provider Name | Kelsey H Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336715895 PECOS PAC ID: 0749674794 Enrollment ID: I20220308001935 |
| Provider Name | Jonathan Ehrhardt |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1639205289 PECOS PAC ID: 4789782228 Enrollment ID: I20220812002172 |
| Provider Name | Diana Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194930917 PECOS PAC ID: 0244410181 Enrollment ID: I20220817000661 |
| Provider Name | Stephanie A Bui |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285196733 PECOS PAC ID: 4789069030 Enrollment ID: I20220923000110 |
| Provider Name | David D Nelsen |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1417184169 PECOS PAC ID: 4183894587 Enrollment ID: I20230209002213 |
| Provider Name | Clark Russell Murray |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1699207241 PECOS PAC ID: 5395018378 Enrollment ID: I20230215001159 |
| Provider Name | Abdulrazzak Zarifa |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1629603139 PECOS PAC ID: 6002273414 Enrollment ID: I20230530002831 |
| Provider Name | Asma Hashim |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780245050 PECOS PAC ID: 4082945233 Enrollment ID: I20230613000178 |
| Provider Name | Derek Michael Willging |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1699318022 PECOS PAC ID: 3476885153 Enrollment ID: I20230623000905 |
| Provider Name | Robb Whinney |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1568480044 PECOS PAC ID: 2860384237 Enrollment ID: I20230627001293 |
| Provider Name | Farhan Shahab |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114549417 PECOS PAC ID: 2961825880 Enrollment ID: I20230628003735 |
| Provider Name | Katlyn D Koskotas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093406837 PECOS PAC ID: 9830559434 Enrollment ID: I20230713003915 |
| Provider Name | Jennifer Kubacik |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1609390087 PECOS PAC ID: 5698135242 Enrollment ID: I20230714001604 |
| Provider Name | Palanikumar Balasundaram |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881180412 PECOS PAC ID: 9739549825 Enrollment ID: I20230720003876 |
| Provider Name | Jessica Sikora |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1487332292 PECOS PAC ID: 9335500271 Enrollment ID: I20230725003223 |
| Provider Name | Abhirami Ravichandran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942652409 PECOS PAC ID: 0941538011 Enrollment ID: I20230808001165 |
| Provider Name | Vasanth Kattalai Kailasam |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1275882730 PECOS PAC ID: 6204116148 Enrollment ID: I20230810000314 |
| Provider Name | Umber Ahmad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083957153 PECOS PAC ID: 1557599941 Enrollment ID: I20230907001960 |
| Provider Name | Jibran Rana |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1043638729 PECOS PAC ID: 8729207865 Enrollment ID: I20230925001165 |
| Provider Name | Hyojin Jeon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578190054 PECOS PAC ID: 2062867302 Enrollment ID: I20231006001324 |
| Provider Name | Julie Bayus |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1275993271 PECOS PAC ID: 4880990977 Enrollment ID: I20231019001859 |
| Provider Name | Julia Kim Leblanc |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1467416990 PECOS PAC ID: 6002805801 Enrollment ID: I20231114001727 |
| Provider Name | William C Leach |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1558399279 PECOS PAC ID: 7719980911 Enrollment ID: I20231117002212 |
| Provider Name | Earl C Williams |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912561077 PECOS PAC ID: 2062839707 Enrollment ID: I20231120001076 |
| Provider Name | Shetal Amin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982135067 PECOS PAC ID: 6406269901 Enrollment ID: I20231206002022 |
| Provider Name | Pauline Galsim |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1902671894 PECOS PAC ID: 7214386879 Enrollment ID: I20231208000905 |
| Provider Name | Matthew Weeks |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619239936 PECOS PAC ID: 6103130653 Enrollment ID: I20231212001505 |
| Provider Name | Christina M Quijano |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356387112 PECOS PAC ID: 6103810171 Enrollment ID: I20240205003038 |
| Provider Name | Andrew Venters Owens |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194168161 PECOS PAC ID: 5496051898 Enrollment ID: I20240305000953 |
Liberty Star Medical Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1905 Center Ave, Suite 5, Janesville, WI 53546 Phone: 608-563-4213 Fax: 866-998-1030 | |
Janesville Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1321 Creston Park Dr, Janesville, WI 53545 Phone: 608-757-1217 | |
Badger Veterinary Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3113 Mccormick Dr, Janesville, WI 53546 Phone: 608-754-1888 | |
Mercy Options Behavioral Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 903 Mineral Point Ave, Janesville, WI 53548 Phone: 608-756-5555 Fax: 608-756-0174 |