| Pine Rest Christian Mental Health Services | |
|
300 68th St Se Grand Rapids MI 49548-6927 | |
| (616) 455-5000 | |
| Not Available |
| Full Name | Pine Rest Christian Mental Health Services |
|---|---|
| Speciality | General Practice |
| Location | 300 68th St Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Diane Fennema (MANAGED CARE ADMINISTRATOR) |
| Authorized Official Contact | 6162816372 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Rest Christian Mental Health Services 300 68th St Se Grand Rapids MI 49548-6927 Ph: (616) 455-5000 | Pine Rest Christian Mental Health Services 300 68th St Se Grand Rapids MI 49548-6927 Ph: (616) 455-5000 |
| NPI Number | 1851309884 |
|---|---|
| Provider Enumeration Date | 08/04/2006 |
| Last Update Date | 11/04/2020 |
| Medicare PECOS PAC ID | 4981506508 |
|---|---|
| Medicare Enrollment ID | O20040216000878 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851309884 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | David E Lyon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508832155 PECOS PAC ID: 4688562291 Enrollment ID: I20040305000904 |
| Provider Name | David N Vigor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235144940 PECOS PAC ID: 4981688389 Enrollment ID: I20040616000015 |
| Provider Name | Kathleen Regan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225056427 PECOS PAC ID: 7517938749 Enrollment ID: I20040803000227 |
| Provider Name | Robert C Shaw |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366474710 PECOS PAC ID: 5991778391 Enrollment ID: I20040813001237 |
| Provider Name | Ali E Ibrahim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710089388 PECOS PAC ID: 1658349212 Enrollment ID: I20040921001007 |
| Provider Name | Carolyn M King |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083783344 PECOS PAC ID: 9335118306 Enrollment ID: I20040927000774 |
| Provider Name | Carolyn S Koppenol |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003964255 PECOS PAC ID: 3779542220 Enrollment ID: I20041008000981 |
| Provider Name | Hyder H Makki |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306027321 PECOS PAC ID: 7719947134 Enrollment ID: I20041012000063 |
| Provider Name | Bruce C Springer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871567735 PECOS PAC ID: 8820983299 Enrollment ID: I20050114000349 |
| Provider Name | Nazimuddin T Mohammed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316974249 PECOS PAC ID: 4284684663 Enrollment ID: I20050124000691 |
| Provider Name | Verle L Bell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962463422 PECOS PAC ID: 2860442134 Enrollment ID: I20050125000296 |
| Provider Name | Curt J Cunningham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982764163 PECOS PAC ID: 1052363793 Enrollment ID: I20050210000781 |
| Provider Name | Sidney E Heisler |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194740118 PECOS PAC ID: 5395797682 Enrollment ID: I20050215000514 |
| Provider Name | Michael M Thebert |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801833819 PECOS PAC ID: 3173570934 Enrollment ID: I20050404000683 |
| Provider Name | Rockelle D Rogers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962596502 PECOS PAC ID: 8123052917 Enrollment ID: I20050921000599 |
| Provider Name | Alberto R Rivera Gutierrez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356394464 PECOS PAC ID: 2769408053 Enrollment ID: I20051017000219 |
| Provider Name | Alan M Armstrong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174579767 PECOS PAC ID: 4385693654 Enrollment ID: I20051108000639 |
| Provider Name | Lawrence M Probes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366465072 PECOS PAC ID: 5395768394 Enrollment ID: I20060105000116 |
| Provider Name | Gary L Rich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285674507 PECOS PAC ID: 6800802190 Enrollment ID: I20060223000352 |
| Provider Name | Philip S Fox |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013976596 PECOS PAC ID: 6406878610 Enrollment ID: I20060315000060 |
| Provider Name | Isha Salva |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801819016 PECOS PAC ID: 2466469218 Enrollment ID: I20060320000340 |
| Provider Name | Peter D Wilkinson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295784619 PECOS PAC ID: 9638060536 Enrollment ID: I20060817000147 |
| Provider Name | Louis J Nykamp |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053383919 PECOS PAC ID: 6608779962 Enrollment ID: I20060901000054 |
| Provider Name | Rebecca Martos Sherwood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447265194 PECOS PAC ID: 3678578317 Enrollment ID: I20061002000254 |
| Provider Name | Marwan S Tabbara |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588759674 PECOS PAC ID: 3577562131 Enrollment ID: I20061207000437 |
| Provider Name | Julia Ailabouni |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376676270 PECOS PAC ID: 8325144595 Enrollment ID: I20070504000021 |
| Provider Name | Eric D Achtyes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780665976 PECOS PAC ID: 0648362343 Enrollment ID: I20070827000376 |
| Provider Name | Kiran Kk Taylor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306945035 PECOS PAC ID: 2466545363 Enrollment ID: I20070910000178 |
| Provider Name | Michael Fusillo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689693020 PECOS PAC ID: 6901988831 Enrollment ID: I20080130000554 |
| Provider Name | Stephen M Prefontaine |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1114953304 PECOS PAC ID: 4183701790 Enrollment ID: I20080407000657 |
| Provider Name | Valerie E Mathis-allen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790732741 PECOS PAC ID: 3274612023 Enrollment ID: I20080505000461 |
| Provider Name | Jack A Mahdasian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841246634 PECOS PAC ID: 0840185070 Enrollment ID: I20080515000530 |
| Provider Name | Teresa Baranowski-birkmeier |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1124082698 PECOS PAC ID: 7911077284 Enrollment ID: I20080529000852 |
| Provider Name | William J Sanders |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528181435 PECOS PAC ID: 3779656715 Enrollment ID: I20080723000788 |
| Provider Name | Kenya M Alexander |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548399108 PECOS PAC ID: 3476626359 Enrollment ID: I20080725000257 |
| Provider Name | Michael A Michelakis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235176249 PECOS PAC ID: 4981778701 Enrollment ID: I20080728000658 |
| Provider Name | Anil K Jain |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013027309 PECOS PAC ID: 0840341905 Enrollment ID: I20090701000018 |
| Provider Name | Chadwick A Furness |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720025166 PECOS PAC ID: 8527120294 Enrollment ID: I20100806000037 |
| Provider Name | William J Walters |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699772442 PECOS PAC ID: 5799746715 Enrollment ID: I20100825000856 |
| Provider Name | Timothy L Todd |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861518789 PECOS PAC ID: 1557353174 Enrollment ID: I20101026000328 |
| Provider Name | Jeffrey W Jackson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598711186 PECOS PAC ID: 9436342110 Enrollment ID: I20101026001257 |
| Provider Name | Talal Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013151547 PECOS PAC ID: 0547455131 Enrollment ID: I20101109000506 |
| Provider Name | Jennifer Palamara |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194738468 PECOS PAC ID: 2365531035 Enrollment ID: I20110104000496 |
| Provider Name | Carey A Krause |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467408229 PECOS PAC ID: 5092904169 Enrollment ID: I20110105001292 |
| Provider Name | Raed H Yousif |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386858603 PECOS PAC ID: 9739358144 Enrollment ID: I20110801000488 |
| Provider Name | Sameh Fs Dwaikat |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609182567 PECOS PAC ID: 4082884911 Enrollment ID: I20110831000493 |
| Provider Name | Aaron John Plattner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285891374 PECOS PAC ID: 8628251113 Enrollment ID: I20110902000588 |
| Provider Name | Cara A Poland |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184890642 PECOS PAC ID: 5294908612 Enrollment ID: I20111101000066 |
| Provider Name | Naudia N Pickens |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366604720 PECOS PAC ID: 2567624992 Enrollment ID: I20120501000842 |
| Provider Name | Cassie Stanton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598961518 PECOS PAC ID: 0042473555 Enrollment ID: I20120521000360 |
| Provider Name | Karen H Leavitt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427210418 PECOS PAC ID: 3577720101 Enrollment ID: I20120801000781 |
| Provider Name | Angela M Jacobs |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144481425 PECOS PAC ID: 5698921344 Enrollment ID: I20120810000794 |
| Provider Name | Ravinderjit Singh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265695563 PECOS PAC ID: 7214183995 Enrollment ID: I20120813000216 |
| Provider Name | Jonathan Dargo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760649594 PECOS PAC ID: 4385891431 Enrollment ID: I20120824000838 |
| Provider Name | Natalie M Wallace |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861639353 PECOS PAC ID: 4284881913 Enrollment ID: I20120830000679 |
| Provider Name | Puneet Singla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558596429 PECOS PAC ID: 5799944666 Enrollment ID: I20121119000212 |
| Provider Name | Peter B Mikhail |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316181308 PECOS PAC ID: 9931362019 Enrollment ID: I20121219000541 |
| Provider Name | Suzanne A Albrecht |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306823232 PECOS PAC ID: 2567419260 Enrollment ID: I20130225000064 |
| Provider Name | James M Eicher |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811217763 PECOS PAC ID: 0648415489 Enrollment ID: I20130326000471 |
| Provider Name | William H Beute |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093761827 PECOS PAC ID: 6901042183 Enrollment ID: I20130412000218 |
| Provider Name | Belal Hegazy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205103793 PECOS PAC ID: 5092956409 Enrollment ID: I20130729000123 |
| Provider Name | Adam D Miller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518128743 PECOS PAC ID: 6800039488 Enrollment ID: I20130829000474 |
| Provider Name | Manav Khullar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164653523 PECOS PAC ID: 4183868185 Enrollment ID: I20130912000568 |
| Provider Name | Mon C Poulose |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982835526 PECOS PAC ID: 5698919652 Enrollment ID: I20130913000436 |
| Provider Name | Bibhas Singla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942432414 PECOS PAC ID: 0648446849 Enrollment ID: I20130926000875 |
| Provider Name | Eric E Erickson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558342220 PECOS PAC ID: 9931157120 Enrollment ID: I20140211000643 |
| Provider Name | Binh Q Dinh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114138633 PECOS PAC ID: 7911190574 Enrollment ID: I20140224001935 |
| Provider Name | Amandeep S Saluja |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588894778 PECOS PAC ID: 5193940708 Enrollment ID: I20140715000963 |
| Provider Name | Madhavi-latha Nagalla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295015717 PECOS PAC ID: 9739305517 Enrollment ID: I20140731001196 |
| Provider Name | Tatjana Maric |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164712055 PECOS PAC ID: 0345469565 Enrollment ID: I20140919000516 |
| Provider Name | Sonia Motin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053672493 PECOS PAC ID: 6002046521 Enrollment ID: I20150128000515 |
| Provider Name | Heide H Rollings |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215257811 PECOS PAC ID: 2668620758 Enrollment ID: I20150717002377 |
| Provider Name | Sri Venkata Uppalapati |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538489810 PECOS PAC ID: 4688987613 Enrollment ID: I20150721000616 |
| Provider Name | Samuel King-yu Lin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053699173 PECOS PAC ID: 1951534254 Enrollment ID: I20150804005113 |
| Provider Name | Vegas V. Coleman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629247267 PECOS PAC ID: 0345327995 Enrollment ID: I20150922002207 |
| Provider Name | Patricia Mary Milner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447541602 PECOS PAC ID: 6800103771 Enrollment ID: I20151007002613 |
| Provider Name | Amy J Laurent |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073670659 PECOS PAC ID: 1951499557 Enrollment ID: I20160502001197 |
| Provider Name | Tiana Ekhande |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255656385 PECOS PAC ID: 6800186784 Enrollment ID: I20160606000931 |
| Provider Name | Jeffrey James Stearns |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144514357 PECOS PAC ID: 1951618180 Enrollment ID: I20160629002375 |
| Provider Name | Swapnil R Rath |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881988038 PECOS PAC ID: 2365743564 Enrollment ID: I20160706002019 |
| Provider Name | Shinji Yasugi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508150376 PECOS PAC ID: 1254641046 Enrollment ID: I20160805001120 |
| Provider Name | Nauman A Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740690023 PECOS PAC ID: 5193941334 Enrollment ID: I20160901001967 |
| Provider Name | Benjamin E Burns |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356605984 PECOS PAC ID: 4082914999 Enrollment ID: I20161018001971 |
| Provider Name | David G Folks |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295794303 PECOS PAC ID: 0042291601 Enrollment ID: I20161230001593 |
| Provider Name | Molly M Mccarthy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386887339 PECOS PAC ID: 0143492223 Enrollment ID: I20170111002771 |
| Provider Name | Aniruddh P Behere |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265689897 PECOS PAC ID: 5092957308 Enrollment ID: I20170126001993 |
| Provider Name | Priya Rana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952643017 PECOS PAC ID: 5193035228 Enrollment ID: I20170522001648 |
| Provider Name | Shady S Shebak |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629416169 PECOS PAC ID: 1951536895 Enrollment ID: I20170705000602 |
| Provider Name | Azhar Abdullah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417351503 PECOS PAC ID: 5294013256 Enrollment ID: I20170712000144 |
| Provider Name | Carmen G Dozeman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497012892 PECOS PAC ID: 9133345382 Enrollment ID: I20170726002590 |
| Provider Name | Folabo Y Dare |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750644548 PECOS PAC ID: 0345486924 Enrollment ID: I20170901002827 |
| Provider Name | Jessica M O'mara |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457766917 PECOS PAC ID: 5890090914 Enrollment ID: I20170914000352 |
| Provider Name | Jonathon Lee Dozeman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851650642 PECOS PAC ID: 9931349057 Enrollment ID: I20170915002151 |
| Provider Name | Barbara Fay Willis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245395029 PECOS PAC ID: 9537153432 Enrollment ID: I20170926002721 |
| Provider Name | Michael L Dozeman |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1487035333 PECOS PAC ID: 9830400407 Enrollment ID: I20170929001915 |
| Provider Name | Barbara A Fitzgerald |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336111574 PECOS PAC ID: 5698849800 Enrollment ID: I20180222001965 |
| Provider Name | Kristina F Hindert |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003873373 PECOS PAC ID: 9032486543 Enrollment ID: I20180529000124 |
| Provider Name | Pratikkumar Vrajeshbhai Desai |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891113171 PECOS PAC ID: 8022364215 Enrollment ID: I20180629002633 |
| Provider Name | Mandeep S Bath |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841698487 PECOS PAC ID: 7911253166 Enrollment ID: I20180702002051 |
| Provider Name | Chaz Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467802645 PECOS PAC ID: 2860788114 Enrollment ID: I20181105001633 |
| Provider Name | Samya Hawley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336351048 PECOS PAC ID: 0042515538 Enrollment ID: I20190423000528 |
| Provider Name | Jamsheed H Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578850277 PECOS PAC ID: 6002133261 Enrollment ID: I20190508002147 |
| Provider Name | Jennifer Rostamabadi-cook |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851831713 PECOS PAC ID: 1153656244 Enrollment ID: I20190711001789 |
| Provider Name | Ali A Saleem |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467867929 PECOS PAC ID: 9436454659 Enrollment ID: I20190716003273 |
| Provider Name | Brenda Manoharan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083035729 PECOS PAC ID: 4486924461 Enrollment ID: I20190805003281 |
| Provider Name | Robert Anthony Siedler |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033522396 PECOS PAC ID: 4880998236 Enrollment ID: I20190909001904 |
| Provider Name | James R Polega |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740700236 PECOS PAC ID: 4486924016 Enrollment ID: I20191001000742 |
| Provider Name | Elmer W Fowler |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760581524 PECOS PAC ID: 0547212284 Enrollment ID: I20191227001121 |
| Provider Name | Sajjad R Sarwar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982839957 PECOS PAC ID: 5294975249 Enrollment ID: I20200427002261 |
| Provider Name | Russell J Yskes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689056715 PECOS PAC ID: 8527363738 Enrollment ID: I20200529000935 |
| Provider Name | Shehryar Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487035127 PECOS PAC ID: 8022314558 Enrollment ID: I20200619000275 |
| Provider Name | Lacey Jo-morford Croskey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285085969 PECOS PAC ID: 8426342247 Enrollment ID: I20200708001678 |
| Provider Name | Afiah A Ahsan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326380783 PECOS PAC ID: 0941574834 Enrollment ID: I20200708002592 |
| Provider Name | Darci L Evans |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407206089 PECOS PAC ID: 3678866860 Enrollment ID: I20200804001859 |
| Provider Name | Jarrad Morgan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760833503 PECOS PAC ID: 2365735586 Enrollment ID: I20200806000880 |
| Provider Name | Cameron J Risma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215319348 PECOS PAC ID: 8921304247 Enrollment ID: I20200820000633 |
| Provider Name | Courtney Aamir Cotter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023504149 PECOS PAC ID: 9436403730 Enrollment ID: I20200915003313 |
| Provider Name | Jennifer Lynn Rosso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821583121 PECOS PAC ID: 2769736156 Enrollment ID: I20200929002801 |
| Provider Name | Lindsey M Bailey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669822250 PECOS PAC ID: 4587957774 Enrollment ID: I20201001000425 |
| Provider Name | Weston Mark Anderson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982134623 PECOS PAC ID: 5698045136 Enrollment ID: I20201015000592 |
| Provider Name | Kyle Thomas Ahonen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326579426 PECOS PAC ID: 7113299918 Enrollment ID: I20210210001558 |
| Provider Name | John R Houskamp |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023063732 PECOS PAC ID: 6709880966 Enrollment ID: I20210406001706 |
| Provider Name | Ryan J Yoon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477082931 PECOS PAC ID: 4880964329 Enrollment ID: I20210716000631 |
| Provider Name | Kara N Hunter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942664644 PECOS PAC ID: 8921390469 Enrollment ID: I20210804000213 |
| Provider Name | Heidi J Vrolijk |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861921041 PECOS PAC ID: 9739459256 Enrollment ID: I20210914002391 |
| Provider Name | Marissa J Martz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275063919 PECOS PAC ID: 4688947799 Enrollment ID: I20210916000339 |
| Provider Name | James Anderson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619008075 PECOS PAC ID: 7517364003 Enrollment ID: I20210927001316 |
| Provider Name | Steven T Hull |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710428974 PECOS PAC ID: 4385918077 Enrollment ID: I20211005001189 |
| Provider Name | Elizabeth Morrow Derose |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265650667 PECOS PAC ID: 0143471797 Enrollment ID: I20211019002861 |
| Provider Name | Katherine M Tontillo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245681873 PECOS PAC ID: 2466745674 Enrollment ID: I20211025000553 |
| Provider Name | Rebecca A Veele |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548822521 PECOS PAC ID: 0042549917 Enrollment ID: I20211110000216 |
| Provider Name | Daniel M Tuinstra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710484274 PECOS PAC ID: 4486901857 Enrollment ID: I20211115002178 |
| Provider Name | Francis P Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174944805 PECOS PAC ID: 0446538409 Enrollment ID: I20211201001279 |
| Provider Name | Ryan D Doyle |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285049742 PECOS PAC ID: 9234434176 Enrollment ID: I20211207001849 |
| Provider Name | Amy Joann Beauchamp |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689137911 PECOS PAC ID: 4082955299 Enrollment ID: I20220427000484 |
| Provider Name | Deborah L Malins |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1184989543 PECOS PAC ID: 1153700885 Enrollment ID: I20220627000317 |
| Provider Name | Christina Rae Heyboer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811525967 PECOS PAC ID: 4587088919 Enrollment ID: I20220720002221 |
| Provider Name | Zachary D Loy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912437245 PECOS PAC ID: 3072883511 Enrollment ID: I20220720002730 |
| Provider Name | Megan E Maier |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831683473 PECOS PAC ID: 9931456308 Enrollment ID: I20220803003127 |
| Provider Name | Andrea L Mcferren |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366995102 PECOS PAC ID: 2466709837 Enrollment ID: I20220908000597 |
| Provider Name | Borhan Darmal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679065536 PECOS PAC ID: 1254682909 Enrollment ID: I20230329002034 |
| Provider Name | Darlinda K Minor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366709396 PECOS PAC ID: 9335427970 Enrollment ID: I20230405000243 |
| Provider Name | Mohammed A Azam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619232758 PECOS PAC ID: 4486943263 Enrollment ID: I20230410001819 |
| Provider Name | Kellen J Stilwell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770080830 PECOS PAC ID: 9638536048 Enrollment ID: I20230530002843 |
| Provider Name | Patrick J Lowry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679555114 PECOS PAC ID: 0648520692 Enrollment ID: I20230707002774 |
| Provider Name | Hannah E Williams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639666209 PECOS PAC ID: 0042670887 Enrollment ID: I20230712002334 |
| Provider Name | Clinton Edward Korneffel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497215008 PECOS PAC ID: 0042546186 Enrollment ID: I20230714002771 |
| Provider Name | Hope Isabel Louise Cohen Webb |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487965026 PECOS PAC ID: 6800062449 Enrollment ID: I20230814003953 |
| Provider Name | Brennan Schiller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154810646 PECOS PAC ID: 0244585610 Enrollment ID: I20231004001485 |
| Provider Name | Nagy A. Youssef |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336156991 PECOS PAC ID: 7719945583 Enrollment ID: I20231218000794 |
| Provider Name | Thomas Roberts |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932774577 PECOS PAC ID: 3375945033 Enrollment ID: I20240117000780 |
| Provider Name | Katerina Georgia Katsoulis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518524966 PECOS PAC ID: 3577898238 Enrollment ID: I20240202001391 |
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American Current Care Of Michigan Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 933 Three Mile Road, Suite 110, Grand Rapids, MI 49544 Phone: 616-785-2619 Fax: 616-785-2623 | |
Patient One Care, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1740 28th St Se, Grand Rapids, MI 49508 Phone: 616-323-3999 Fax: 616-552-1618 | |
Elite Health, Plc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 Fulton St E, Suite A, Grand Rapids, MI 49503 Phone: 616-644-1423 Fax: 616-773-1291 | |
Cherry Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Cherry St Se, Grand Rapids, MI 49503 Phone: 616-965-8200 | |
Dr Asif Azeem Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1200 East Paris Ave Se, Ste 8, Grand Rapids, MI 49546 Phone: 616-942-6230 Fax: 616-942-6270 |