| Phelps Health Medical Group Rolla | |
|
1050 W 10th St Rolla MO 65401-2905 | |
| (573) 364-9000 | |
| (573) 458-3952 |
| Full Name | Phelps Health Medical Group Rolla |
|---|---|
| Speciality | Clinic/Center |
| Location | 1050 W 10th St, Rolla, Missouri |
| Authorized Official Name and Position | Jana M Cook (VP, CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5734587916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phelps Health Medical Group Rolla Po Box 579 Rolla MO 65402 Ph: (573) 426-2182 | Phelps Health Medical Group Rolla 1050 W 10th St Rolla MO 65401-2905 Ph: (573) 364-9000 |
| NPI Number | 1124237227 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 11/22/2023 |
| Medicare PECOS PAC ID | 1557454063 |
|---|---|
| Medicare Enrollment ID | O20070829000437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124237227 | NPI | - | NPPES |
| 507013605 | Medicaid | MO | |
| 591072301 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Timothy J Martin |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1366486722 PECOS PAC ID: 9638073430 Enrollment ID: I20031124000160 |
| Provider Name | Sellas P Coble |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629097035 PECOS PAC ID: 0941100820 Enrollment ID: I20040109000115 |
| Provider Name | Chun H So |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1851315410 PECOS PAC ID: 7911807730 Enrollment ID: I20040109000335 |
| Provider Name | Dana Voight |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1588684401 PECOS PAC ID: 4284534017 Enrollment ID: I20040109000394 |
| Provider Name | Robert Pearson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1316960008 PECOS PAC ID: 4688574411 Enrollment ID: I20040109000434 |
| Provider Name | Christopher L Johnson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1154337202 PECOS PAC ID: 0749241073 Enrollment ID: I20041020001018 |
| Provider Name | Bhaskar Y Gowda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750367967 PECOS PAC ID: 7416910849 Enrollment ID: I20041108000226 |
| Provider Name | Mohammad A Choudhary |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1700836962 PECOS PAC ID: 5890759492 Enrollment ID: I20041115000018 |
| Provider Name | Muhammad Baber |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497769194 PECOS PAC ID: 3476518200 Enrollment ID: I20041122000346 |
| Provider Name | Todd Riggs |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1922114008 PECOS PAC ID: 2163417122 Enrollment ID: I20050504000363 |
| Provider Name | Larry P Mazzeo |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1669466892 PECOS PAC ID: 5395778765 Enrollment ID: I20050915000718 |
| Provider Name | Malik Ahmed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770557985 PECOS PAC ID: 5294752648 Enrollment ID: I20051026000073 |
| Provider Name | Kimberly D Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396717104 PECOS PAC ID: 9032186036 Enrollment ID: I20060818000019 |
| Provider Name | Barbara C Fulton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447241146 PECOS PAC ID: 7416957758 Enrollment ID: I20070110000242 |
| Provider Name | James J Bass |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336130079 PECOS PAC ID: 4486655727 Enrollment ID: I20070129000723 |
| Provider Name | Syed Z Zahoor Ul Mueen |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1790895597 PECOS PAC ID: 6507968518 Enrollment ID: I20070222000172 |
| Provider Name | Stacey Marie Monaco |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1043283625 PECOS PAC ID: 7517063076 Enrollment ID: I20070501000142 |
| Provider Name | Beth J Gearhart |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1215959101 PECOS PAC ID: 8123126901 Enrollment ID: I20070601000042 |
| Provider Name | Wendolyn M Di Salvo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871668798 PECOS PAC ID: 7810096948 Enrollment ID: I20070629000512 |
| Provider Name | Keith J Frederick |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1366552762 PECOS PAC ID: 3678529294 Enrollment ID: I20070831000280 |
| Provider Name | Susan Toebben |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215136569 PECOS PAC ID: 5799879961 Enrollment ID: I20070919000134 |
| Provider Name | Crystal L Fleener |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447442678 PECOS PAC ID: 4486742087 Enrollment ID: I20071115000228 |
| Provider Name | Sandra K Headrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891786414 PECOS PAC ID: 8426138421 Enrollment ID: I20080103000308 |
| Provider Name | Nathan K Ratchford |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588874242 PECOS PAC ID: 3072671429 Enrollment ID: I20081029000304 |
| Provider Name | Jeffery A Kerr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831152370 PECOS PAC ID: 7618874447 Enrollment ID: I20081105000368 |
| Provider Name | Craig E Tatom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225286347 PECOS PAC ID: 1153485784 Enrollment ID: I20090127000444 |
| Provider Name | Sarah M Mckee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932367901 PECOS PAC ID: 8527115500 Enrollment ID: I20090408000381 |
| Provider Name | Steven R Ballard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043454564 PECOS PAC ID: 1658422928 Enrollment ID: I20090626000041 |
| Provider Name | Corinne Sundar Rao |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1255325643 PECOS PAC ID: 3375688047 Enrollment ID: I20100305000116 |
| Provider Name | Yvonne M Prince |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538150222 PECOS PAC ID: 7618012055 Enrollment ID: I20100309000891 |
| Provider Name | Robert G Swanson |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1114969144 PECOS PAC ID: 5799840146 Enrollment ID: I20100511000789 |
| Provider Name | Davinder James Singh Hayreh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538288394 PECOS PAC ID: 6507981990 Enrollment ID: I20100908000637 |
| Provider Name | Rachelle L Gorrell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336114800 PECOS PAC ID: 0042335226 Enrollment ID: I20100910000788 |
| Provider Name | Evelyn A Aboagye |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1194992172 PECOS PAC ID: 1254456734 Enrollment ID: I20100921001024 |
| Provider Name | Bohdan A Lebedowicz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023087731 PECOS PAC ID: 5294794186 Enrollment ID: I20101220000159 |
| Provider Name | Brian R Kriete |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1134319858 PECOS PAC ID: 7911186986 Enrollment ID: I20110122000060 |
| Provider Name | Nurelign Gashu Abebe |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1154587038 PECOS PAC ID: 3173700077 Enrollment ID: I20110601000647 |
| Provider Name | Helen L Litz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942223813 PECOS PAC ID: 5294909859 Enrollment ID: I20111116000293 |
| Provider Name | Robert Anthony Bergamini |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1962462846 PECOS PAC ID: 0345401295 Enrollment ID: I20120419000693 |
| Provider Name | Matthew Warren Hurley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821362088 PECOS PAC ID: 9830352129 Enrollment ID: I20120524000210 |
| Provider Name | Wesley C Harden |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1790947885 PECOS PAC ID: 7719136027 Enrollment ID: I20121002000339 |
| Provider Name | Michael S Potter |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1770748154 PECOS PAC ID: 1153507041 Enrollment ID: I20121002000721 |
| Provider Name | Thomas F Satterly |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1174759203 PECOS PAC ID: 5092992032 Enrollment ID: I20121009000486 |
| Provider Name | Jonathan R Beers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477783686 PECOS PAC ID: 0244419851 Enrollment ID: I20121024000407 |
| Provider Name | Lisa A Cunningham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790037950 PECOS PAC ID: 1951552579 Enrollment ID: I20121108000079 |
| Provider Name | Gerardo Ismael G Gueco |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1417289463 PECOS PAC ID: 4587801311 Enrollment ID: I20130514000653 |
| Provider Name | Christine G Durbin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689735128 PECOS PAC ID: 4688813058 Enrollment ID: I20130614000283 |
| Provider Name | Naveen Yarasi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689804262 PECOS PAC ID: 4183867013 Enrollment ID: I20130826000315 |
| Provider Name | Jenny L Pennycook |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1134357320 PECOS PAC ID: 8426287467 Enrollment ID: I20140214001115 |
| Provider Name | Curtis Morrison |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1528409638 PECOS PAC ID: 4789808965 Enrollment ID: I20140609001276 |
| Provider Name | Jinna M Lisenbe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245658335 PECOS PAC ID: 1759505472 Enrollment ID: I20140618001918 |
| Provider Name | Matthew Joseph Bond |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1801036728 PECOS PAC ID: 9537385661 Enrollment ID: I20140728000501 |
| Provider Name | Chadwell B Vail |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467733022 PECOS PAC ID: 7517187768 Enrollment ID: I20141010000077 |
| Provider Name | Karen Ulrich |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1922416296 PECOS PAC ID: 9032339239 Enrollment ID: I20141010001784 |
| Provider Name | Shawna C Gifford |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1598053498 PECOS PAC ID: 8527299189 Enrollment ID: I20141015002380 |
| Provider Name | Sandy R Marshall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316341944 PECOS PAC ID: 1456573716 Enrollment ID: I20141121000338 |
| Provider Name | Abdalla M Oun |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1992089619 PECOS PAC ID: 1456673474 Enrollment ID: I20141202002201 |
| Provider Name | Becky L Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386047025 PECOS PAC ID: 5799007225 Enrollment ID: I20141211000542 |
| Provider Name | Leah Kathleen Bond |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1629460878 PECOS PAC ID: 7416277595 Enrollment ID: I20150514000291 |
| Provider Name | Cory L.s. Offutt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811330806 PECOS PAC ID: 8022320415 Enrollment ID: I20150626000657 |
| Provider Name | Alan D Heincker |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1023304037 PECOS PAC ID: 4486966884 Enrollment ID: I20150626000995 |
| Provider Name | Christopher R Spencer |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1568775567 PECOS PAC ID: 6709016694 Enrollment ID: I20150723009149 |
| Provider Name | Jennifer M O Malley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831458033 PECOS PAC ID: 5193049674 Enrollment ID: I20150831001017 |
| Provider Name | Aaron B Cohlmia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841661170 PECOS PAC ID: 0941510259 Enrollment ID: I20151116002556 |
| Provider Name | Michael A Holland |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1538423561 PECOS PAC ID: 0244464121 Enrollment ID: I20160706001742 |
| Provider Name | John-paul Soberano |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1760708747 PECOS PAC ID: 4486956018 Enrollment ID: I20160729001846 |
| Provider Name | Amber Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740631969 PECOS PAC ID: 2365737277 Enrollment ID: I20160816003048 |
| Provider Name | Kan Huang |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1598095622 PECOS PAC ID: 8921308776 Enrollment ID: I20161010000516 |
| Provider Name | Candy L Sadler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043761521 PECOS PAC ID: 7113206376 Enrollment ID: I20161111000833 |
| Provider Name | Qamar U Zaman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1497036552 PECOS PAC ID: 9436451861 Enrollment ID: I20161219001581 |
| Provider Name | Hadia Choudhry Crider |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487094140 PECOS PAC ID: 0244514438 Enrollment ID: I20170308000282 |
| Provider Name | Emily J Wiseman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700327897 PECOS PAC ID: 5092092197 Enrollment ID: I20170427000425 |
| Provider Name | Miriam L Brawley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033646187 PECOS PAC ID: 4183992704 Enrollment ID: I20170622000659 |
| Provider Name | Rachel Ann Feeler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265952295 PECOS PAC ID: 2163791336 Enrollment ID: I20170630001615 |
| Provider Name | Candace Kay Chafton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497285159 PECOS PAC ID: 0547539157 Enrollment ID: I20170712003111 |
| Provider Name | Joel Amos Leon Becerril |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1013295419 PECOS PAC ID: 4284927617 Enrollment ID: I20170817003358 |
| Provider Name | Ariella Lee S Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497278378 PECOS PAC ID: 8729353891 Enrollment ID: I20170929001883 |
| Provider Name | Stilianos Efstratiadis |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1437328556 PECOS PAC ID: 2668522319 Enrollment ID: I20171214001904 |
| Provider Name | Hye-jung Jang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073015418 PECOS PAC ID: 5294097515 Enrollment ID: I20180327001582 |
| Provider Name | Michelle Marie Hill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679894232 PECOS PAC ID: 6800159757 Enrollment ID: I20180706000192 |
| Provider Name | Michel J Adonis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1497190854 PECOS PAC ID: 5991096380 Enrollment ID: I20180716000954 |
| Provider Name | Josie Leann Eoff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659857415 PECOS PAC ID: 2668720905 Enrollment ID: I20180802003509 |
| Provider Name | Cody W Sells |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790279230 PECOS PAC ID: 8628326337 Enrollment ID: I20180810002640 |
| Provider Name | Rachael Williams |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1558755629 PECOS PAC ID: 8022366749 Enrollment ID: I20180813000094 |
| Provider Name | Lincoln T Shenje |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1700031382 PECOS PAC ID: 7517107006 Enrollment ID: I20181002003904 |
| Provider Name | Megan Elizabeth Redwine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265906200 PECOS PAC ID: 0244571388 Enrollment ID: I20190418000076 |
| Provider Name | Gregory Douglas Gibbs |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1346791225 PECOS PAC ID: 7113262007 Enrollment ID: I20190605002066 |
| Provider Name | Khang T Nguyen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568717114 PECOS PAC ID: 0840523890 Enrollment ID: I20190606002773 |
| Provider Name | Thomas A Guerrero-garcia |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1689939993 PECOS PAC ID: 8123256963 Enrollment ID: I20190624002596 |
| Provider Name | Mary S Doellman |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1417117854 PECOS PAC ID: 1850694506 Enrollment ID: I20190709000390 |
| Provider Name | Oluwafunmilola Alabi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649624214 PECOS PAC ID: 5294020558 Enrollment ID: I20190726000092 |
| Provider Name | Anaid Hernandez-sanchez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871949461 PECOS PAC ID: 1355677469 Enrollment ID: I20190727000151 |
| Provider Name | Virginia Avahnel Wingler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669033825 PECOS PAC ID: 7911233846 Enrollment ID: I20190730001951 |
| Provider Name | Chaitanya Ravi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457723462 PECOS PAC ID: 4981907433 Enrollment ID: I20191022000738 |
| Provider Name | Salli Lamberth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245877620 PECOS PAC ID: 2961836903 Enrollment ID: I20191227000051 |
| Provider Name | Logan Jay Shockley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295374148 PECOS PAC ID: 2769819788 Enrollment ID: I20200303001577 |
| Provider Name | Jennifer Keeler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962027235 PECOS PAC ID: 4981026176 Enrollment ID: I20200616002639 |
| Provider Name | Brandon Keith Lamberth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770192957 PECOS PAC ID: 7618393661 Enrollment ID: I20200820002430 |
| Provider Name | Brittany Mechelle Waterworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447868005 PECOS PAC ID: 4183041510 Enrollment ID: I20200901000386 |
| Provider Name | Tracy L Mccoy Maloskey |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1508177064 PECOS PAC ID: 3072737659 Enrollment ID: I20200916001578 |
| Provider Name | Sylvester T Youlo |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1992021430 PECOS PAC ID: 2769615285 Enrollment ID: I20200924002924 |
| Provider Name | Chimnoya N Nwagwu-youlo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1881910487 PECOS PAC ID: 2769613611 Enrollment ID: I20200930001385 |
| Provider Name | Mylhan Ih Myers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639699747 PECOS PAC ID: 5890067441 Enrollment ID: I20201001000867 |
| Provider Name | Sarah M Mckee |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1932367901 PECOS PAC ID: 8527115500 Enrollment ID: I20201204002202 |
| Provider Name | Shannon Liane Robinson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639256738 PECOS PAC ID: 3779539572 Enrollment ID: I20210511000886 |
| Provider Name | Fawad Virk |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1396150165 PECOS PAC ID: 6608094297 Enrollment ID: I20210604001107 |
| Provider Name | Derrick Clunis |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1407832579 PECOS PAC ID: 8527058015 Enrollment ID: I20210712003291 |
| Provider Name | John R Carr |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154816858 PECOS PAC ID: 5698027837 Enrollment ID: I20210805001683 |
| Provider Name | Nabiha N Awan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1902303555 PECOS PAC ID: 7810242997 Enrollment ID: I20210812001956 |
| Provider Name | Jerry Jianzhang Pan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871086769 PECOS PAC ID: 3476959420 Enrollment ID: I20210831001626 |
| Provider Name | Sara Meek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669056941 PECOS PAC ID: 3577961713 Enrollment ID: I20211001002007 |
| Provider Name | Michelle Ann Hassard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558023903 PECOS PAC ID: 7618365347 Enrollment ID: I20211028001420 |
| Provider Name | Andrea Renee Crossley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225619091 PECOS PAC ID: 0547651317 Enrollment ID: I20220126000646 |
| Provider Name | Amanda Groebl Judilla |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1225324569 PECOS PAC ID: 7315326584 Enrollment ID: I20220617000982 |
| Provider Name | Mohammed A Siddiqui |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1508228669 PECOS PAC ID: 8820382328 Enrollment ID: I20220809001212 |
| Provider Name | Sara Ann Bayless |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811642044 PECOS PAC ID: 4183009285 Enrollment ID: I20220909000967 |
| Provider Name | Richelle Nicole Brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225534167 PECOS PAC ID: 4880941293 Enrollment ID: I20221006003106 |
| Provider Name | David Moravec |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1144751843 PECOS PAC ID: 9234401597 Enrollment ID: I20221013000608 |
| Provider Name | Paige Loring Alvarado |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1316669781 PECOS PAC ID: 0143696708 Enrollment ID: I20221022000117 |
| Provider Name | Jordan Marie Priest |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790410751 PECOS PAC ID: 8820465206 Enrollment ID: I20221028001023 |
| Provider Name | Mark Louis Greenberg |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1043219967 PECOS PAC ID: 8729001607 Enrollment ID: I20221109002111 |
| Provider Name | Sydney Kay Fryer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912616277 PECOS PAC ID: 1759750870 Enrollment ID: I20221213001191 |
| Provider Name | Arun Gautam |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1649621293 PECOS PAC ID: 5698060887 Enrollment ID: I20221227000766 |
| Provider Name | Smruthi Sanath Kumar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750510640 PECOS PAC ID: 0244553733 Enrollment ID: I20230127001253 |
| Provider Name | Jennie Lyn Orlando |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508570326 PECOS PAC ID: 1254703382 Enrollment ID: I20230217001333 |
| Provider Name | Angela K Watkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720545999 PECOS PAC ID: 2668868373 Enrollment ID: I20230329000867 |
| Provider Name | Peter Muigai Mwariri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841994043 PECOS PAC ID: 6204201353 Enrollment ID: I20230404000552 |
| Provider Name | Abigail Laine Blanc |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710672944 PECOS PAC ID: 4981069721 Enrollment ID: I20230428002398 |
| Provider Name | John Ashton Armstrong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427679232 PECOS PAC ID: 5294197943 Enrollment ID: I20230814001105 |
| Provider Name | Kourtney Leigh Buhler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689350019 PECOS PAC ID: 5597127159 Enrollment ID: I20230814002000 |
| Provider Name | Shruti Sinha |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1801414552 PECOS PAC ID: 7719349893 Enrollment ID: I20230822002033 |
| Provider Name | Lacey E Stockton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710763065 PECOS PAC ID: 2668828799 Enrollment ID: I20231026001135 |
| Provider Name | Kathryn Grace Finley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578277356 PECOS PAC ID: 9931573813 Enrollment ID: I20231214001564 |
| Provider Name | Megan Janece Mcbride |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750158630 PECOS PAC ID: 1254782626 Enrollment ID: I20240110001755 |
Goodman Medical Center Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 715 State Route Cc, Rolla, MO 65401 Phone: 573-308-5044 Fax: 573-341-5300 | |
Phelps County Regional Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1000 W 10th St, Rolla, MO 65401 Phone: 573-458-8899 | |
Four Rivers Community Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1081 E 18th St, Rolla, MO 65401 Phone: 573-426-2407 | |
Radiology - Rolla Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1000 W 10th St, Rolla, MO 65401 Phone: 573-364-9000 | |
Choudhrymd, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 604 W 6th St, Rolla, MO 65401 Phone: 573-202-3969 Fax: 573-341-8581 | |
Your Community Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 N Main St, Suite 51g, Rolla, MO 65401 Phone: 573-426-6712 Fax: 573-426-6735 |