| Physicians' Billing Of Mgh | |
|
330 N Wabash Avenue Suite G20 Marion IN 46952-2600 | |
| (765) 660-7600 | |
| (765) 651-7313 |
| Full Name | Physicians' Billing Of Mgh |
|---|---|
| Speciality | Family Medicine |
| Location | 330 N Wabash Avenue, Marion, Indiana |
| Authorized Official Name and Position | Stephanie Hilton-siebert (PRESIDENT/CEO) |
| Authorized Official Contact | 7656607007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Physicians' Billing Of Mgh 330 North Wabash Avenue Suite G20 Marion IN 46952-2600 Ph: (765) 662-4133 | Physicians' Billing Of Mgh 330 N Wabash Avenue Suite G20 Marion IN 46952-2600 Ph: (765) 660-7600 |
| NPI Number | 1528099041 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 06/16/2020 |
| Medicare PECOS PAC ID | 9133023625 |
|---|---|
| Medicare Enrollment ID | O20040524001483 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528099041 | NPI | - | NPPES |
| 100269250 | Medicaid | IN |
| Provider Name | Sirajabid Khatib |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1396737524 PECOS PAC ID: 0244133692 Enrollment ID: I20040202000060 |
| Provider Name | Peter M Knapp |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1013921709 PECOS PAC ID: 0840194627 Enrollment ID: I20040213000013 |
| Provider Name | David H Soper |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114922929 PECOS PAC ID: 9931093440 Enrollment ID: I20040213000224 |
| Provider Name | Jerry Ray Powell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619958378 PECOS PAC ID: 5698661775 Enrollment ID: I20040225000749 |
| Provider Name | James M Orrell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447220900 PECOS PAC ID: 9931012481 Enrollment ID: I20040616000908 |
| Provider Name | Mark Allen Westfall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093785552 PECOS PAC ID: 9931183860 Enrollment ID: I20040617000037 |
| Provider Name | Jeffrey Wayne Bragg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518937697 PECOS PAC ID: 3375527211 Enrollment ID: I20040617000057 |
| Provider Name | Carole E Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093820896 PECOS PAC ID: 1355329830 Enrollment ID: I20040712000109 |
| Provider Name | Jeremy R Wilson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1518930015 PECOS PAC ID: 0143293415 Enrollment ID: I20040816000333 |
| Provider Name | Monika Rajmaira |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306828231 PECOS PAC ID: 6800855065 Enrollment ID: I20041005000451 |
| Provider Name | Vahid-david Sedaghat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972584043 PECOS PAC ID: 5496714941 Enrollment ID: I20041008000991 |
| Provider Name | Kay F Johnson-keys |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043247190 PECOS PAC ID: 4587621271 Enrollment ID: I20041214000940 |
| Provider Name | Etta Kathryn Nevel |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588616627 PECOS PAC ID: 7113970716 Enrollment ID: I20050223000632 |
| Provider Name | Sandra L Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861482648 PECOS PAC ID: 4183664147 Enrollment ID: I20050509001030 |
| Provider Name | Karl C Cytrynowicz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598746109 PECOS PAC ID: 6901832062 Enrollment ID: I20050711000717 |
| Provider Name | Shankaran Srikanth |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356440887 PECOS PAC ID: 6002847159 Enrollment ID: I20050829000237 |
| Provider Name | James Erbowor Becksen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497723696 PECOS PAC ID: 5991719577 Enrollment ID: I20060202000866 |
| Provider Name | Susan M Frayer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598757684 PECOS PAC ID: 5092720391 Enrollment ID: I20060207001008 |
| Provider Name | Benerji Gudapati |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1962459099 PECOS PAC ID: 5092712166 Enrollment ID: I20061102000288 |
| Provider Name | Kristine Agnes Knapp |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1033140678 PECOS PAC ID: 5698773190 Enrollment ID: I20061116000485 |
| Provider Name | Timothy Coakley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073559985 PECOS PAC ID: 9133128713 Enrollment ID: I20061208000133 |
| Provider Name | Lisa A Decker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346359437 PECOS PAC ID: 6608971122 Enrollment ID: I20070411000522 |
| Provider Name | Rameshchandra I Patel |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1487757811 PECOS PAC ID: 0042250862 Enrollment ID: I20070412000431 |
| Provider Name | Jitendra I Patel |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1821192253 PECOS PAC ID: 9133169956 Enrollment ID: I20070412000452 |
| Provider Name | Supriya Kumar |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1801886205 PECOS PAC ID: 4880641216 Enrollment ID: I20070418000587 |
| Provider Name | Stephen J Jasinski |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386660256 PECOS PAC ID: 2961507835 Enrollment ID: I20070425000538 |
| Provider Name | Venkata K Kancherla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427153170 PECOS PAC ID: 8820189186 Enrollment ID: I20070808000011 |
| Provider Name | June H Pollydore |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043376429 PECOS PAC ID: 3476646829 Enrollment ID: I20070830000750 |
| Provider Name | Jacqueline Suzanne Cole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083818835 PECOS PAC ID: 2860581436 Enrollment ID: I20071204000772 |
| Provider Name | Ruth E Swanson Bainbridge |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104807874 PECOS PAC ID: 2961582697 Enrollment ID: I20080107000684 |
| Provider Name | Gladys E Black |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205011715 PECOS PAC ID: 3577649474 Enrollment ID: I20080318000341 |
| Provider Name | Kavita Raj |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669456059 PECOS PAC ID: 8022195098 Enrollment ID: I20080402000156 |
| Provider Name | Daniel J Edwards |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1194880146 PECOS PAC ID: 5890735617 Enrollment ID: I20080624000028 |
| Provider Name | Douglas A Rex |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1912185661 PECOS PAC ID: 7012083876 Enrollment ID: I20080903000248 |
| Provider Name | Carolyn J Lane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497911051 PECOS PAC ID: 3274601679 Enrollment ID: I20081013000480 |
| Provider Name | Jeremy A Hawk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508011081 PECOS PAC ID: 6507921947 Enrollment ID: I20090218000241 |
| Provider Name | Edward W Irick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649275553 PECOS PAC ID: 6709933575 Enrollment ID: I20090414000122 |
| Provider Name | Lisa L Yarger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548232259 PECOS PAC ID: 5890845143 Enrollment ID: I20090609000218 |
| Provider Name | Anna M Steinbarger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336148352 PECOS PAC ID: 1759433279 Enrollment ID: I20090714000792 |
| Provider Name | Edmond A Bendaly |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1285835652 PECOS PAC ID: 8426101528 Enrollment ID: I20090807000211 |
| Provider Name | Jeffrey S Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871731935 PECOS PAC ID: 8729132592 Enrollment ID: I20090812000838 |
| Provider Name | Marie Nowak |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1033272943 PECOS PAC ID: 5496801706 Enrollment ID: I20090928000506 |
| Provider Name | Ruben Gonzales |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609974922 PECOS PAC ID: 8022105550 Enrollment ID: I20091013000417 |
| Provider Name | Derrick L Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922333194 PECOS PAC ID: 2365584661 Enrollment ID: I20100126000006 |
| Provider Name | Emil A Balasandiran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205935731 PECOS PAC ID: 0042346306 Enrollment ID: I20100326000137 |
| Provider Name | Todd W Duerfeldt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861557944 PECOS PAC ID: 0840274650 Enrollment ID: I20100518000642 |
| Provider Name | Rodolfo Echeverria |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1861408486 PECOS PAC ID: 1052203866 Enrollment ID: I20100519000159 |
| Provider Name | Earl F Beaupied |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669419909 PECOS PAC ID: 2163576109 Enrollment ID: I20100520000097 |
| Provider Name | Marcie L Baird |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447577275 PECOS PAC ID: 5294865598 Enrollment ID: I20100614000164 |
| Provider Name | Teresa A Templin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750362406 PECOS PAC ID: 8820128812 Enrollment ID: I20100618000187 |
| Provider Name | Emily Barrido Kabigting |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1295716892 PECOS PAC ID: 0648316307 Enrollment ID: I20100618000251 |
| Provider Name | Rathipriya Mahendran |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1982685533 PECOS PAC ID: 5092755801 Enrollment ID: I20100618000302 |
| Provider Name | Ala Shiyab |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1265679187 PECOS PAC ID: 7517099112 Enrollment ID: I20100717000033 |
| Provider Name | Brenda K Woods |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851511737 PECOS PAC ID: 6608853411 Enrollment ID: I20100722000323 |
| Provider Name | Constantine G Scordalakes |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437235645 PECOS PAC ID: 9537198080 Enrollment ID: I20100803000425 |
| Provider Name | Noreen C Faulkner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1932196409 PECOS PAC ID: 1456496157 Enrollment ID: I20100917000756 |
| Provider Name | Shawn T Swan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1881697027 PECOS PAC ID: 3779521901 Enrollment ID: I20101021000007 |
| Provider Name | Lisa M Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134438286 PECOS PAC ID: 5395931026 Enrollment ID: I20101120000079 |
| Provider Name | Alvin Gene Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568573145 PECOS PAC ID: 4486833480 Enrollment ID: I20110124000242 |
| Provider Name | Karen Jacobs |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1801886908 PECOS PAC ID: 4385853761 Enrollment ID: I20110201000792 |
| Provider Name | Jeffrey W Miller |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1285682625 PECOS PAC ID: 9436339421 Enrollment ID: I20110208000832 |
| Provider Name | Michelle A Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366621484 PECOS PAC ID: 6103008750 Enrollment ID: I20110303000467 |
| Provider Name | Jamie S Lang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962708156 PECOS PAC ID: 3274716543 Enrollment ID: I20110323000796 |
| Provider Name | Jeremy P Spaulding |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1093988263 PECOS PAC ID: 1658557947 Enrollment ID: I20110523000222 |
| Provider Name | Adam J Patrick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679746127 PECOS PAC ID: 6204013618 Enrollment ID: I20110613000637 |
| Provider Name | Muni K Theertham |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1114183449 PECOS PAC ID: 0648448605 Enrollment ID: I20110718000388 |
| Provider Name | Benjamin G Martin |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1942414800 PECOS PAC ID: 1557539566 Enrollment ID: I20110719000097 |
| Provider Name | Michael A Gunter |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1285636415 PECOS PAC ID: 5597897108 Enrollment ID: I20111116000571 |
| Provider Name | George E Geier |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1679554646 PECOS PAC ID: 3072553890 Enrollment ID: I20111222000121 |
| Provider Name | Noaman F Siddiqi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124294749 PECOS PAC ID: 7618157470 Enrollment ID: I20120530000010 |
| Provider Name | Kristan L Higginbotham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467715094 PECOS PAC ID: 2769638022 Enrollment ID: I20120802000283 |
| Provider Name | Aisha Jennings |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255566261 PECOS PAC ID: 6305096868 Enrollment ID: I20121019000081 |
| Provider Name | Omar A Hasnie |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174767644 PECOS PAC ID: 2365694536 Enrollment ID: I20121214000450 |
| Provider Name | Melissa A Wood-heller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487995858 PECOS PAC ID: 1557508264 Enrollment ID: I20130516000123 |
| Provider Name | Nabin K Agrawal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356656250 PECOS PAC ID: 3577706951 Enrollment ID: I20130904000511 |
| Provider Name | Janardhanan V Davy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1033435425 PECOS PAC ID: 9133363625 Enrollment ID: I20130924000327 |
| Provider Name | Vishaal Veerula |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336441948 PECOS PAC ID: 5496983033 Enrollment ID: I20140106000852 |
| Provider Name | Kimberly A Lovelady |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912333279 PECOS PAC ID: 7214165471 Enrollment ID: I20140115000146 |
| Provider Name | Anthony P Collins |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376730903 PECOS PAC ID: 5193897239 Enrollment ID: I20140117001726 |
| Provider Name | Ewa Kalinowska |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427345438 PECOS PAC ID: 2163652322 Enrollment ID: I20140308000235 |
| Provider Name | Musa Abdalla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548552375 PECOS PAC ID: 5193957520 Enrollment ID: I20140416002392 |
| Provider Name | Martin Pruss |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053363861 PECOS PAC ID: 6800811985 Enrollment ID: I20140730001429 |
| Provider Name | Riley D Rose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356776918 PECOS PAC ID: 6901023092 Enrollment ID: I20140813002438 |
| Provider Name | Kenneth James Welch |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578511044 PECOS PAC ID: 7618031576 Enrollment ID: I20150330000215 |
| Provider Name | Stephanie J Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871972281 PECOS PAC ID: 3779803952 Enrollment ID: I20150529001286 |
| Provider Name | Stephen M Keller |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679864599 PECOS PAC ID: 6709002405 Enrollment ID: I20150611001119 |
| Provider Name | Rebecca E Waugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962888677 PECOS PAC ID: 7113233990 Enrollment ID: I20150825005093 |
| Provider Name | Betty J Guerin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811372915 PECOS PAC ID: 1456668672 Enrollment ID: I20150921000178 |
| Provider Name | Linda L Simpkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427433861 PECOS PAC ID: 8022326289 Enrollment ID: I20151007003100 |
| Provider Name | Seshadri Jagannathan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104114784 PECOS PAC ID: 1254641269 Enrollment ID: I20151103002560 |
| Provider Name | Connie I Elliott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942669130 PECOS PAC ID: 2961709910 Enrollment ID: I20160318001288 |
| Provider Name | Michelle L Hart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356709604 PECOS PAC ID: 9739486838 Enrollment ID: I20160404001499 |
| Provider Name | Nagesh Anjinappa |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1629335963 PECOS PAC ID: 6406072982 Enrollment ID: I20160518001170 |
| Provider Name | Phyllis Harman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255787453 PECOS PAC ID: 1355632654 Enrollment ID: I20160616001026 |
| Provider Name | Vinodha Nagesh |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194954560 PECOS PAC ID: 2961540992 Enrollment ID: I20160624000954 |
| Provider Name | Kellie R Planck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144680679 PECOS PAC ID: 0840582409 Enrollment ID: I20160630001126 |
| Provider Name | Dina Malak Mourice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619336096 PECOS PAC ID: 3678865458 Enrollment ID: I20160714002396 |
| Provider Name | Eric E Emery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538515515 PECOS PAC ID: 4587958673 Enrollment ID: I20160812000419 |
| Provider Name | Kyle R Speakman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104269240 PECOS PAC ID: 5294979233 Enrollment ID: I20160906000216 |
| Provider Name | Kim Rashada |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427140664 PECOS PAC ID: 2365464450 Enrollment ID: I20160914002797 |
| Provider Name | Frances L Harvey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952859811 PECOS PAC ID: 4981991411 Enrollment ID: I20160927000290 |
| Provider Name | Christina F Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174935068 PECOS PAC ID: 1456648872 Enrollment ID: I20160928000816 |
| Provider Name | Awais Masood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164607669 PECOS PAC ID: 1951595289 Enrollment ID: I20161006002395 |
| Provider Name | Kiran Babu Chikkalingaiah |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1598982712 PECOS PAC ID: 1951549310 Enrollment ID: I20161115001647 |
| Provider Name | Muhammad Naeem Ahmad |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1184016073 PECOS PAC ID: 4284919655 Enrollment ID: I20170327001736 |
| Provider Name | Lora E Marshall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871032045 PECOS PAC ID: 4284911298 Enrollment ID: I20170501000094 |
| Provider Name | Benjamin Olugbenga Adebayo |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437415460 PECOS PAC ID: 1052615184 Enrollment ID: I20170705001492 |
| Provider Name | Porus Shah |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1447652953 PECOS PAC ID: 3375813173 Enrollment ID: I20170727001815 |
| Provider Name | Matthew A Eaton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205247384 PECOS PAC ID: 1850696931 Enrollment ID: I20170804002316 |
| Provider Name | Cristy R Mullinix |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639699879 PECOS PAC ID: 5395019459 Enrollment ID: I20170928000581 |
| Provider Name | Richard S Goodstein |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1841307923 PECOS PAC ID: 9436166998 Enrollment ID: I20171218001533 |
| Provider Name | Carlos M Blanchard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689109415 PECOS PAC ID: 6002174109 Enrollment ID: I20171219001582 |
| Provider Name | Melo Dee L Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215327705 PECOS PAC ID: 3577821552 Enrollment ID: I20171220002564 |
| Provider Name | James Watkins Lowry |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982656690 PECOS PAC ID: 5092757690 Enrollment ID: I20171226000023 |
| Provider Name | Patricia E Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801304423 PECOS PAC ID: 8527328830 Enrollment ID: I20180206002221 |
| Provider Name | Erica Jefferies |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699262014 PECOS PAC ID: 6002171139 Enrollment ID: I20180521000926 |
| Provider Name | Mirza M Baig |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1134371487 PECOS PAC ID: 2567651938 Enrollment ID: I20180607000736 |
| Provider Name | John F Hanson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942649546 PECOS PAC ID: 8527290766 Enrollment ID: I20180609000253 |
| Provider Name | Nda Mhlophe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477935542 PECOS PAC ID: 0143575209 Enrollment ID: I20180614000884 |
| Provider Name | Imran A Sethi |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1093914301 PECOS PAC ID: 0244313500 Enrollment ID: I20180615001865 |
| Provider Name | Michella Azar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922480201 PECOS PAC ID: 9234441346 Enrollment ID: I20180724003408 |
| Provider Name | Brian Anthony Neal |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932542263 PECOS PAC ID: 6800106709 Enrollment ID: I20180731001718 |
| Provider Name | Kristine D Colyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679064190 PECOS PAC ID: 8729338967 Enrollment ID: I20180907002639 |
| Provider Name | Nadeem Najam |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1982669495 PECOS PAC ID: 9032178934 Enrollment ID: I20181012000679 |
| Provider Name | Bindu B Nair |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427042597 PECOS PAC ID: 7315914454 Enrollment ID: I20190319001080 |
| Provider Name | Daphne Kyomuhendo Muzoora |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1467772624 PECOS PAC ID: 2769622554 Enrollment ID: I20190327001871 |
| Provider Name | Sajid A Shakhan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194165860 PECOS PAC ID: 6709017445 Enrollment ID: I20190523001624 |
| Provider Name | Harrison Lobdell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154775740 PECOS PAC ID: 4284922378 Enrollment ID: I20190530001513 |
| Provider Name | Mohammad Sami Bakdash |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104271790 PECOS PAC ID: 8628361037 Enrollment ID: I20190715000718 |
| Provider Name | Weafue Saab |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780941690 PECOS PAC ID: 5698993525 Enrollment ID: I20190813000726 |
| Provider Name | Rachel Brinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093277295 PECOS PAC ID: 6204163165 Enrollment ID: I20190815000175 |
| Provider Name | Georges Debal |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1316386386 PECOS PAC ID: 4880923085 Enrollment ID: I20190913000957 |
| Provider Name | Lindsey Leeana Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336608066 PECOS PAC ID: 6204167810 Enrollment ID: I20191014000815 |
| Provider Name | David King |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952751844 PECOS PAC ID: 8123315785 Enrollment ID: I20191023002162 |
| Provider Name | Amber Nicole Banks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972152114 PECOS PAC ID: 4880026772 Enrollment ID: I20191114001606 |
| Provider Name | Raul Zambrano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598736472 PECOS PAC ID: 1951375096 Enrollment ID: I20191212001891 |
| Provider Name | David Kosturakis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952669277 PECOS PAC ID: 5496995953 Enrollment ID: I20191231001702 |
| Provider Name | Riad Hassan Al Natour |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891059077 PECOS PAC ID: 2365680600 Enrollment ID: I20200116000265 |
| Provider Name | Andrea Lynn Detamore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356992077 PECOS PAC ID: 1759718844 Enrollment ID: I20200302002381 |
| Provider Name | Porcha Leggett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962948935 PECOS PAC ID: 8820372709 Enrollment ID: I20200716000752 |
| Provider Name | Mina S Youssef |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447783683 PECOS PAC ID: 3173893971 Enrollment ID: I20200831000709 |
| Provider Name | Jeanette Hoeksema |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023162070 PECOS PAC ID: 7719901115 Enrollment ID: I20201203000207 |
| Provider Name | Connie J Braun |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194899641 PECOS PAC ID: 7810949914 Enrollment ID: I20201209003193 |
| Provider Name | Woodley Desir |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1447405576 PECOS PAC ID: 3971812538 Enrollment ID: I20210317001080 |
| Provider Name | Nitin R Sharma |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1548460553 PECOS PAC ID: 1355628694 Enrollment ID: I20210319000336 |
| Provider Name | Faisal Noorzad |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1689038853 PECOS PAC ID: 4688912322 Enrollment ID: I20210507001742 |
| Provider Name | Emily E Thomas |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255836532 PECOS PAC ID: 5496080533 Enrollment ID: I20210713002865 |
| Provider Name | Prakash Karna |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1376031104 PECOS PAC ID: 8022412485 Enrollment ID: I20210806000745 |
| Provider Name | John Alfred Carr |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1457353658 PECOS PAC ID: 1557318177 Enrollment ID: I20210824002176 |
| Provider Name | Aamer Javed |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1346737491 PECOS PAC ID: 0840546073 Enrollment ID: I20210830002523 |
| Provider Name | Imran Hayat Tarrar |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1639510662 PECOS PAC ID: 4880987759 Enrollment ID: I20210920000976 |
| Provider Name | Danielle E Hamlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609541978 PECOS PAC ID: 6204233083 Enrollment ID: I20210921002471 |
| Provider Name | Charles E Cossell |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1295129849 PECOS PAC ID: 6002117165 Enrollment ID: I20210921002925 |
| Provider Name | Matthew P Noyes |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1922282219 PECOS PAC ID: 6901871557 Enrollment ID: I20211026000968 |
| Provider Name | Paul Garverick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356832521 PECOS PAC ID: 3678828746 Enrollment ID: I20220119001046 |
| Provider Name | Rukeme Ake-uzoigwe |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1477959419 PECOS PAC ID: 7113298340 Enrollment ID: I20220211001165 |
| Provider Name | Chelsea Faye Kolodziej |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407484264 PECOS PAC ID: 5496146839 Enrollment ID: I20220425000541 |
| Provider Name | Lindsay Renee Harness |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982359881 PECOS PAC ID: 4789071192 Enrollment ID: I20220503000707 |
| Provider Name | Lani B Stearns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821745852 PECOS PAC ID: 5092102475 Enrollment ID: I20220504000889 |
| Provider Name | Miranda Jo Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104552421 PECOS PAC ID: 6800271719 Enrollment ID: I20220913003052 |
| Provider Name | Priti Babubhai Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851013189 PECOS PAC ID: 7214312701 Enrollment ID: I20220920001385 |
| Provider Name | Dhiraj Shah |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1053965392 PECOS PAC ID: 8123404944 Enrollment ID: I20221003000905 |
| Provider Name | Brittany Hope Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245941715 PECOS PAC ID: 6800266743 Enrollment ID: I20230110001810 |
| Provider Name | John J. Anagnostou |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1023435930 PECOS PAC ID: 4587930771 Enrollment ID: I20230118001434 |
| Provider Name | Vikram Chatrath |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1205264074 PECOS PAC ID: 1254567449 Enrollment ID: I20230206000461 |
| Provider Name | Kelsi Christine Fulda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992409478 PECOS PAC ID: 3870958481 Enrollment ID: I20230504001499 |
| Provider Name | Fatih Burak Kaner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215547542 PECOS PAC ID: 4789041492 Enrollment ID: I20230611000075 |
| Provider Name | Carlos Llanes Alvarez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497384309 PECOS PAC ID: 7810355070 Enrollment ID: I20230620002026 |
| Provider Name | Rachel L Gutfreund |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1013574912 PECOS PAC ID: 3072847169 Enrollment ID: I20230913003817 |
| Provider Name | Rei Christian Salinas Calma |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1962060343 PECOS PAC ID: 7315272358 Enrollment ID: I20230927001592 |
| Provider Name | Beth J Gearhart |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1215959101 PECOS PAC ID: 8123126901 Enrollment ID: I20230928002208 |
| Provider Name | Basel Imam |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1245573542 PECOS PAC ID: 2365711785 Enrollment ID: I20231108002033 |
| Provider Name | Timothy John Custer |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1144211418 PECOS PAC ID: 1951389782 Enrollment ID: I20231114003275 |
| Provider Name | Hannah Renfrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487022810 PECOS PAC ID: 2567810492 Enrollment ID: I20231202000171 |
| Provider Name | Kayla Marie Korporal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285413351 PECOS PAC ID: 8123477395 Enrollment ID: I20231213001758 |
| Provider Name | Leah Rashell Broyles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750163960 PECOS PAC ID: 0446603674 Enrollment ID: I20240124002158 |
Ihc Grant-blackford Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 116 E 32nd St Ste A, Marion, IN 46953 Phone: 765-664-7492 Fax: 765-400-4466 | |
Marion Primary Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1614 N Baldwin Ave, Marion, IN 46952 Phone: 765-664-9000 | |
Earnest Associates Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 203 S Washington St, Marion, IN 46952 Phone: 765-668-1500 Fax: 765-668-2790 | |
Everside Health, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2707 S. Westrn Ave, Marion, IN 46953 Phone: 765-697-9142 Fax: 765-697-9143 | |
Hospitalists Of Mgh Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 441 N Wabash Ave, Marion, IN 46952 Phone: 765-662-4133 | |
Thrive Lagerkvist Medical Services, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1105 N Western Ave, Marion, IN 46952 Phone: 765-613-0111 Fax: 765-662-8502 | |
Bridges To Health Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 119 S Washington St, Marion, IN 46952 Phone: 765-662-7289 Fax: 765-662-4708 |