| Proctor Health Systems | |
|
5401 N Knoxville Ave Suite 209 Peoria IL 61614-5098 | |
| (309) 689-6049 | |
| (309) 689-6092 |
| Full Name | Proctor Health Systems |
|---|---|
| Speciality | Family Medicine |
| Location | 5401 N Knoxville Ave, Peoria, Illinois |
| Authorized Official Name and Position | Carrie Chiaravalle (DIRECTOR) |
| Authorized Official Contact | 3096896049 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proctor Health Systems 5401 N Knoxville Ave Suite 209 Peoria IL 61614-5098 Ph: (309) 689-6049 | Proctor Health Systems 5401 N Knoxville Ave Suite 209 Peoria IL 61614-5098 Ph: (309) 689-6049 |
| NPI Number | 1134173917 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 11/01/2007 |
| Medicare PECOS PAC ID | 3476440173 |
|---|---|
| Medicare Enrollment ID | O20040227000906 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134173917 | NPI | - | NPPES |
| 7232122 | Other | IL | BC BS OF ILLINOIS |
| CD8124 | Other | IL | RAILROAD MEDICARE |
| CD8123 | Other | IL | RAILROAD MEDICARE |
| Provider Name | Maria Rhodora T Kabatay Lee Ho |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174560353 PECOS PAC ID: 9739085713 Enrollment ID: I20031210000528 |
| Provider Name | Thembi A Conner-garcia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629092226 PECOS PAC ID: 3870499536 Enrollment ID: I20031211000973 |
| Provider Name | Cheryl L Wegman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174590889 PECOS PAC ID: 9537069273 Enrollment ID: I20040109000997 |
| Provider Name | James Morse |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134135627 PECOS PAC ID: 5193626596 Enrollment ID: I20040119000329 |
| Provider Name | David G Springer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205931318 PECOS PAC ID: 7618860032 Enrollment ID: I20040207000205 |
| Provider Name | Thomas B Golemon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619981370 PECOS PAC ID: 9739076779 Enrollment ID: I20040303000611 |
| Provider Name | Jayalakshmi Attaluri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245251255 PECOS PAC ID: 6406748987 Enrollment ID: I20040329000733 |
| Provider Name | Jianming Dong |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619981305 PECOS PAC ID: 8527051473 Enrollment ID: I20040406001046 |
| Provider Name | Michael Patrick Honan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255424750 PECOS PAC ID: 6901891753 Enrollment ID: I20040420000230 |
| Provider Name | Douglas J Marshall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477569499 PECOS PAC ID: 5092702092 Enrollment ID: I20040503000287 |
| Provider Name | Riaz H Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003823220 PECOS PAC ID: 5698763639 Enrollment ID: I20040506000256 |
| Provider Name | Shawn A Seibert |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437166717 PECOS PAC ID: 8729076773 Enrollment ID: I20040506000316 |
| Provider Name | Patricia J Estep |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003818675 PECOS PAC ID: 9830180306 Enrollment ID: I20040522000017 |
| Provider Name | Kathleen M Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669422135 PECOS PAC ID: 2466430467 Enrollment ID: I20040707001289 |
| Provider Name | Syed Omar A Bukhari |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225052434 PECOS PAC ID: 8022096494 Enrollment ID: I20040712000840 |
| Provider Name | Andy C Chiou |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1063454197 PECOS PAC ID: 0941288211 Enrollment ID: I20040713000004 |
| Provider Name | Brian Cohen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710991856 PECOS PAC ID: 8325024755 Enrollment ID: I20040809000550 |
| Provider Name | Subhash J Patel |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1891986907 PECOS PAC ID: 9133193576 Enrollment ID: I20040825000276 |
| Provider Name | Kelly Ann Adcock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386707354 PECOS PAC ID: 0446224448 Enrollment ID: I20040825000322 |
| Provider Name | Richard D Harvey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740259068 PECOS PAC ID: 5092780163 Enrollment ID: I20040901000177 |
| Provider Name | Mark Montefolka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114026754 PECOS PAC ID: 7214905728 Enrollment ID: I20040922000841 |
| Provider Name | Baljit Singh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528075769 PECOS PAC ID: 7810958758 Enrollment ID: I20041022001120 |
| Provider Name | Joshua J Schupbach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447267711 PECOS PAC ID: 2769444934 Enrollment ID: I20041029000864 |
| Provider Name | Angela A Golby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639183536 PECOS PAC ID: 4587626627 Enrollment ID: I20041101000304 |
| Provider Name | Adel F Mina |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316962749 PECOS PAC ID: 5193786572 Enrollment ID: I20041101000320 |
| Provider Name | Ravindra Kashyap |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1437145273 PECOS PAC ID: 2466416441 Enrollment ID: I20041118000845 |
| Provider Name | Alexander A Adler |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1912929118 PECOS PAC ID: 8123084472 Enrollment ID: I20041208000369 |
| Provider Name | Mario E Cote |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376514273 PECOS PAC ID: 0941268080 Enrollment ID: I20041221000750 |
| Provider Name | Walter S Reid |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1932180387 PECOS PAC ID: 9830177104 Enrollment ID: I20050310000447 |
| Provider Name | Matthew A Stetter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205935848 PECOS PAC ID: 2567418601 Enrollment ID: I20050322001056 |
| Provider Name | Hilton M Hudson |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1689614828 PECOS PAC ID: 7911984513 Enrollment ID: I20050509000334 |
| Provider Name | Sunitha Nair |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689672933 PECOS PAC ID: 0042114183 Enrollment ID: I20050622000633 |
| Provider Name | Mohammad A Toor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841289691 PECOS PAC ID: 2264426212 Enrollment ID: I20050628000341 |
| Provider Name | Connie A Duda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881669760 PECOS PAC ID: 2769418219 Enrollment ID: I20050715000307 |
| Provider Name | Timothy Lahood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245223130 PECOS PAC ID: 7416973458 Enrollment ID: I20051019000915 |
| Provider Name | Donald L Yakel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1568559359 PECOS PAC ID: 0840217022 Enrollment ID: I20051027000257 |
| Provider Name | Tina M Schaffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558380246 PECOS PAC ID: 5799705653 Enrollment ID: I20051207000115 |
| Provider Name | Jeanna Marie Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922061043 PECOS PAC ID: 3577585678 Enrollment ID: I20060103000367 |
| Provider Name | Michael R. Johnson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285640276 PECOS PAC ID: 8224052725 Enrollment ID: I20060124000324 |
| Provider Name | Revathi Swaminathan |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1841234929 PECOS PAC ID: 2961416185 Enrollment ID: I20060126000835 |
| Provider Name | Angela B Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275608432 PECOS PAC ID: 4284648122 Enrollment ID: I20060131000576 |
| Provider Name | Amy Marie Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164561130 PECOS PAC ID: 7810907276 Enrollment ID: I20060428000418 |
| Provider Name | Ryan D Schmidgall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548204779 PECOS PAC ID: 1456315977 Enrollment ID: I20060726000071 |
| Provider Name | Kashif S Haque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285679704 PECOS PAC ID: 3476566001 Enrollment ID: I20060726000078 |
| Provider Name | Thomas E Halperin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689615163 PECOS PAC ID: 4688687007 Enrollment ID: I20060801000045 |
| Provider Name | Barbara Lynn Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184696544 PECOS PAC ID: 3779586912 Enrollment ID: I20060809000042 |
| Provider Name | Mourad Alnatour |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891734257 PECOS PAC ID: 0941203483 Enrollment ID: I20060823000039 |
| Provider Name | Vinoda Shanthappa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518986512 PECOS PAC ID: 8729082805 Enrollment ID: I20060901000060 |
| Provider Name | Roby A Lal |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1811983489 PECOS PAC ID: 9335102888 Enrollment ID: I20060926000212 |
| Provider Name | Marion Willemsen Reid |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1720029283 PECOS PAC ID: 2365448990 Enrollment ID: I20061004000561 |
| Provider Name | Debra K Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023103314 PECOS PAC ID: 9638176654 Enrollment ID: I20061103000221 |
| Provider Name | Devashish Agarwal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841382298 PECOS PAC ID: 0648277590 Enrollment ID: I20061107000151 |
| Provider Name | James F Hensold |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013011394 PECOS PAC ID: 4688583131 Enrollment ID: I20070521000509 |
| Provider Name | Darren J Conklin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255451803 PECOS PAC ID: 4385738178 Enrollment ID: I20070925000124 |
| Provider Name | Nicolaas Michael Jongerius |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235144056 PECOS PAC ID: 0547354342 Enrollment ID: I20070925000302 |
| Provider Name | Lori A Mayo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366407892 PECOS PAC ID: 2466548029 Enrollment ID: I20071012000609 |
| Provider Name | Thomas Santoro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801818448 PECOS PAC ID: 4587751730 Enrollment ID: I20071105000156 |
| Provider Name | Dean L Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205850278 PECOS PAC ID: 5193802155 Enrollment ID: I20080402000085 |
| Provider Name | Thomas Kouri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568412773 PECOS PAC ID: 1052490232 Enrollment ID: I20080430000313 |
| Provider Name | Renaldo Jacques |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477528974 PECOS PAC ID: 9739268913 Enrollment ID: I20080430000344 |
| Provider Name | Sahar Halabi |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1003937350 PECOS PAC ID: 9931271764 Enrollment ID: I20080710000424 |
| Provider Name | Narayana Reddy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306880281 PECOS PAC ID: 7810060167 Enrollment ID: I20080718000477 |
| Provider Name | Pablo Ermelo G Perez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578658993 PECOS PAC ID: 7113090085 Enrollment ID: I20080725000159 |
| Provider Name | Mohammed Irfan Shakaib |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225243462 PECOS PAC ID: 6406929280 Enrollment ID: I20080728000185 |
| Provider Name | Jolyne N Kaar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073711024 PECOS PAC ID: 9830265073 Enrollment ID: I20080911000467 |
| Provider Name | Jacob Tony |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881815488 PECOS PAC ID: 9830257484 Enrollment ID: I20081025000101 |
| Provider Name | Generoso N Sison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609085273 PECOS PAC ID: 8426118142 Enrollment ID: I20081125000223 |
| Provider Name | Asim K Jaffer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316193543 PECOS PAC ID: 2062573520 Enrollment ID: I20081203000302 |
| Provider Name | Rachel S Grieder |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1598926289 PECOS PAC ID: 8123189495 Enrollment ID: I20081204000635 |
| Provider Name | Jay S Harms |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518075282 PECOS PAC ID: 9739158544 Enrollment ID: I20090326000571 |
| Provider Name | Christine M Greene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891861407 PECOS PAC ID: 8820145816 Enrollment ID: I20090408000436 |
| Provider Name | Brandon M Bockewitz |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1619199627 PECOS PAC ID: 4789731571 Enrollment ID: I20090414000357 |
| Provider Name | Tahir B Ilahi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1194974964 PECOS PAC ID: 2769530211 Enrollment ID: I20090511000393 |
| Provider Name | Todd A Lanser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376765891 PECOS PAC ID: 2466502828 Enrollment ID: I20090608000102 |
| Provider Name | Thaw Tun |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326142902 PECOS PAC ID: 9638229339 Enrollment ID: I20090617000572 |
| Provider Name | Housam E Soukieh |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1568422673 PECOS PAC ID: 1254482631 Enrollment ID: I20090624000577 |
| Provider Name | Dustin W Kern |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1750517488 PECOS PAC ID: 0547311615 Enrollment ID: I20090701000052 |
| Provider Name | Troy M Green |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1588890214 PECOS PAC ID: 4981755055 Enrollment ID: I20090701000064 |
| Provider Name | Srihari D Nair |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1295828846 PECOS PAC ID: 4789737487 Enrollment ID: I20090728000644 |
| Provider Name | Rehman Usmani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114170073 PECOS PAC ID: 9638222185 Enrollment ID: I20090730000303 |
| Provider Name | Gulzar Fidai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851398218 PECOS PAC ID: 9133028749 Enrollment ID: I20100108000384 |
| Provider Name | Michael A Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255421558 PECOS PAC ID: 8527109768 Enrollment ID: I20100109000105 |
| Provider Name | Jennifer N Ali |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992039440 PECOS PAC ID: 8123155066 Enrollment ID: I20100423000548 |
| Provider Name | Tad A Yetter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245296979 PECOS PAC ID: 5496749657 Enrollment ID: I20100508000142 |
| Provider Name | Erin Md Martin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457573818 PECOS PAC ID: 9032249586 Enrollment ID: I20100610000508 |
| Provider Name | Lee T. Kinsinger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417983487 PECOS PAC ID: 9830104397 Enrollment ID: I20100611000728 |
| Provider Name | William Charles Hicok |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457326944 PECOS PAC ID: 5890827687 Enrollment ID: I20100714000315 |
| Provider Name | Vijaya L Jujjavarapu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750356226 PECOS PAC ID: 3779615505 Enrollment ID: I20100714000742 |
| Provider Name | Robert A Meister |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114992229 PECOS PAC ID: 5890827349 Enrollment ID: I20100719000411 |
| Provider Name | Jill M Egizio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508902941 PECOS PAC ID: 6709919558 Enrollment ID: I20100730000915 |
| Provider Name | Michael R Whitford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164439980 PECOS PAC ID: 2769442458 Enrollment ID: I20100816000382 |
| Provider Name | Vaughn E Hanna |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1912912213 PECOS PAC ID: 6406980275 Enrollment ID: I20100816000420 |
| Provider Name | Chad M Conklin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659395259 PECOS PAC ID: 6507990389 Enrollment ID: I20100816000522 |
| Provider Name | Azizur Rehman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336156611 PECOS PAC ID: 7113051996 Enrollment ID: I20100816000553 |
| Provider Name | Stephanie M Lindstrom |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811903073 PECOS PAC ID: 1355465634 Enrollment ID: I20100824001036 |
| Provider Name | Robert Allan Lizer |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1184624280 PECOS PAC ID: 5496870651 Enrollment ID: I20100913000462 |
| Provider Name | Mustafa Mohammed Ali |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1184857138 PECOS PAC ID: 4789709858 Enrollment ID: I20100913000694 |
| Provider Name | Jeffrey Y Liang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679540330 PECOS PAC ID: 0749306678 Enrollment ID: I20100928000954 |
| Provider Name | Shahid Wazir |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548440803 PECOS PAC ID: 7315139961 Enrollment ID: I20101014000501 |
| Provider Name | Aiyub Patel |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1215153077 PECOS PAC ID: 3375737687 Enrollment ID: I20101101000614 |
| Provider Name | John Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174539761 PECOS PAC ID: 4082808126 Enrollment ID: I20101102000892 |
| Provider Name | Antoine J Dawalibi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982618930 PECOS PAC ID: 4587858626 Enrollment ID: I20101102000969 |
| Provider Name | Samuel D Andrews |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1851508337 PECOS PAC ID: 5496940181 Enrollment ID: I20101108000717 |
| Provider Name | Anil K Reddivari |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1164687968 PECOS PAC ID: 0648467365 Enrollment ID: I20101207001201 |
| Provider Name | Thomas R Rossi |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1851320238 PECOS PAC ID: 6305736851 Enrollment ID: I20101217000859 |
| Provider Name | David L Crawford |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306874128 PECOS PAC ID: 0941190490 Enrollment ID: I20101221000112 |
| Provider Name | Parth Mehta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750557815 PECOS PAC ID: 1759579568 Enrollment ID: I20101221000498 |
| Provider Name | Shams B Ilahi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801058409 PECOS PAC ID: 4284823220 Enrollment ID: I20110106000832 |
| Provider Name | Timothy J Lawless |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982679569 PECOS PAC ID: 9032308960 Enrollment ID: I20110107000714 |
| Provider Name | Pooja Gupta |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1205044062 PECOS PAC ID: 1052592029 Enrollment ID: I20110223001038 |
| Provider Name | Raj Haribhai Ughreja |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982857926 PECOS PAC ID: 9830367788 Enrollment ID: I20110719000749 |
| Provider Name | James P Ausfahl |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518058619 PECOS PAC ID: 6406024983 Enrollment ID: I20110728000156 |
| Provider Name | Jamaluddin F Amanullah |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1184673147 PECOS PAC ID: 4385622323 Enrollment ID: I20110802000270 |
| Provider Name | Prem L Bhatia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720179773 PECOS PAC ID: 6608045364 Enrollment ID: I20110815000273 |
| Provider Name | Dominique K Fons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134391881 PECOS PAC ID: 7810168614 Enrollment ID: I20110928000419 |
| Provider Name | Kristin Brown-danzeisen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386929206 PECOS PAC ID: 0042484248 Enrollment ID: I20111128000774 |
| Provider Name | Mohammed A Mubeen |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1578720777 PECOS PAC ID: 8325203474 Enrollment ID: I20120622000610 |
| Provider Name | Kurt L Glesne |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1346508280 PECOS PAC ID: 5698924959 Enrollment ID: I20121001000310 |
| Provider Name | Karen S Nenne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760733992 PECOS PAC ID: 1052564796 Enrollment ID: I20130109000283 |
| Provider Name | Lissa J Diefendorf |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1427356336 PECOS PAC ID: 5890948913 Enrollment ID: I20130123000206 |
| Provider Name | Mansoor Ahmad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194059600 PECOS PAC ID: 4385898154 Enrollment ID: I20130201000119 |
| Provider Name | Rehan Mohammed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356511901 PECOS PAC ID: 9739357179 Enrollment ID: I20130502000308 |
| Provider Name | Karen S Wilson-guinto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790026425 PECOS PAC ID: 6608014071 Enrollment ID: I20130523000492 |
| Provider Name | Aneesh Neekhra |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134384548 PECOS PAC ID: 6406910660 Enrollment ID: I20130710000192 |
| Provider Name | Amber N Avila |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295056737 PECOS PAC ID: 0547432312 Enrollment ID: I20130809000208 |
| Provider Name | John Lidvall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376856559 PECOS PAC ID: 9830323757 Enrollment ID: I20131009000406 |
| Provider Name | Lariven Beltran Franada |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023334596 PECOS PAC ID: 7416182563 Enrollment ID: I20131028001142 |
| Provider Name | Ibrahim Shamsi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710207105 PECOS PAC ID: 5597991646 Enrollment ID: I20131119000722 |
| Provider Name | Nikki Lynn L Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528400850 PECOS PAC ID: 6709019151 Enrollment ID: I20140509000436 |
| Provider Name | Jennifer Smidt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538588298 PECOS PAC ID: 5193948826 Enrollment ID: I20140527000365 |
| Provider Name | Lihua Du |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215198320 PECOS PAC ID: 7315100450 Enrollment ID: I20140624001764 |
| Provider Name | Venkat R Kakollu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1447681044 PECOS PAC ID: 7315163565 Enrollment ID: I20140723001822 |
| Provider Name | Julie A Driscoll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720405541 PECOS PAC ID: 3375761273 Enrollment ID: I20140905000464 |
| Provider Name | Kara Marino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295141471 PECOS PAC ID: 1951521913 Enrollment ID: I20140925002257 |
| Provider Name | May Sun |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1629365424 PECOS PAC ID: 9234350406 Enrollment ID: I20141101000001 |
| Provider Name | Tiereny N Minassian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497150221 PECOS PAC ID: 0143442715 Enrollment ID: I20141114001469 |
| Provider Name | Jennifer A Vissering |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770983181 PECOS PAC ID: 0648592642 Enrollment ID: I20141202001421 |
| Provider Name | April Marielaine Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346649209 PECOS PAC ID: 0345562088 Enrollment ID: I20141208000429 |
| Provider Name | Pawan D Sarda |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1063720993 PECOS PAC ID: 5890018758 Enrollment ID: I20141229001078 |
| Provider Name | Danielle Nicole Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932507720 PECOS PAC ID: 0840514931 Enrollment ID: I20150120001903 |
| Provider Name | Tamra J Chan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588066427 PECOS PAC ID: 4284959800 Enrollment ID: I20150202001470 |
| Provider Name | Lisa Friebohle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629466743 PECOS PAC ID: 5799001624 Enrollment ID: I20150311001672 |
| Provider Name | Fizza Deen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952664013 PECOS PAC ID: 3072839976 Enrollment ID: I20150312001505 |
| Provider Name | Catherine F Lang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124437868 PECOS PAC ID: 9234456047 Enrollment ID: I20150316000825 |
| Provider Name | Shriram Lokare |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1497057905 PECOS PAC ID: 0345477238 Enrollment ID: I20150716002617 |
| Provider Name | Andrew Cusack |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578827523 PECOS PAC ID: 8820319668 Enrollment ID: I20150812007409 |
| Provider Name | Samantha A Leverton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891161030 PECOS PAC ID: 1355656448 Enrollment ID: I20150819006675 |
| Provider Name | Radha K Gurumurthy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821423583 PECOS PAC ID: 9830407642 Enrollment ID: I20150928002659 |
| Provider Name | Fadi Aljabi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1790890556 PECOS PAC ID: 0648279919 Enrollment ID: I20150930000027 |
| Provider Name | Jonathan A Rider |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437526852 PECOS PAC ID: 0648588186 Enrollment ID: I20151001002353 |
| Provider Name | Anne Rene Webster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124495379 PECOS PAC ID: 6204144686 Enrollment ID: I20151005001606 |
| Provider Name | Janelle Arletta Fenski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790154532 PECOS PAC ID: 9739499336 Enrollment ID: I20151111001741 |
| Provider Name | John C Heyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750310363 PECOS PAC ID: 0941262265 Enrollment ID: I20151202002437 |
| Provider Name | Ann Pearl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689049421 PECOS PAC ID: 5698076842 Enrollment ID: I20151214001124 |
| Provider Name | Stephanie Rinehart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730594037 PECOS PAC ID: 0840592242 Enrollment ID: I20151231000417 |
| Provider Name | Lionel J Malebranche |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1033390521 PECOS PAC ID: 0244456267 Enrollment ID: I20160107001231 |
| Provider Name | April Summers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063898914 PECOS PAC ID: 5496051229 Enrollment ID: I20160304000251 |
| Provider Name | Kathryn Grahs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730549510 PECOS PAC ID: 0941508741 Enrollment ID: I20160412000805 |
| Provider Name | Michael R Brown |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1912007642 PECOS PAC ID: 3870579667 Enrollment ID: I20160503000007 |
| Provider Name | Gregory Aubert |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1346506839 PECOS PAC ID: 8224335542 Enrollment ID: I20160513000195 |
| Provider Name | Danielle R Pray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972989838 PECOS PAC ID: 4385933217 Enrollment ID: I20160517001505 |
| Provider Name | Michelle Valentine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689045775 PECOS PAC ID: 1951690379 Enrollment ID: I20160525000250 |
| Provider Name | Jessica Secor |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1164700183 PECOS PAC ID: 8022231802 Enrollment ID: I20160623001451 |
| Provider Name | Jami M Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144606195 PECOS PAC ID: 6002108693 Enrollment ID: I20160629002488 |
| Provider Name | Kory T Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669823068 PECOS PAC ID: 5193018083 Enrollment ID: I20160729002124 |
| Provider Name | Thomas Choorapokayil George |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922448018 PECOS PAC ID: 5294029666 Enrollment ID: I20160808001566 |
| Provider Name | Janell K Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265883490 PECOS PAC ID: 5496049363 Enrollment ID: I20160816001220 |
| Provider Name | Teri L Rizzo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821541558 PECOS PAC ID: 0648565218 Enrollment ID: I20160822000685 |
| Provider Name | Aneta Monika Kowalska |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063754158 PECOS PAC ID: 6002126166 Enrollment ID: I20160823000395 |
| Provider Name | Anota Akofu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215376140 PECOS PAC ID: 9537301395 Enrollment ID: I20160829000580 |
| Provider Name | Jamie Schupbach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932554714 PECOS PAC ID: 7012203045 Enrollment ID: I20160831000360 |
| Provider Name | Micah D Boehr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134560139 PECOS PAC ID: 9739400805 Enrollment ID: I20160909001218 |
| Provider Name | Katherine L Merila |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083168447 PECOS PAC ID: 5294021408 Enrollment ID: I20160914000011 |
| Provider Name | Ashley N Brandt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215480587 PECOS PAC ID: 5890081962 Enrollment ID: I20160916000106 |
| Provider Name | Tarah Noel Gibbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114472610 PECOS PAC ID: 8527355296 Enrollment ID: I20160922002840 |
| Provider Name | Carlos Miguel Avila |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386059624 PECOS PAC ID: 9133345762 Enrollment ID: I20160927000248 |
| Provider Name | Emily J Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457807646 PECOS PAC ID: 3678861770 Enrollment ID: I20161005000978 |
| Provider Name | Jennifer Greenwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316492432 PECOS PAC ID: 5799073748 Enrollment ID: I20161007000416 |
| Provider Name | Dragica Durman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275930299 PECOS PAC ID: 1951699271 Enrollment ID: I20161019000809 |
| Provider Name | John Voris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790125193 PECOS PAC ID: 7315268109 Enrollment ID: I20161025001149 |
| Provider Name | Gowri Subramaniyan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295175438 PECOS PAC ID: 6103058284 Enrollment ID: I20161027002449 |
| Provider Name | Amanda Neudorf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093266108 PECOS PAC ID: 5890074447 Enrollment ID: I20161122001811 |
| Provider Name | Christian Stremmel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710437249 PECOS PAC ID: 3476832924 Enrollment ID: I20161128001258 |
| Provider Name | Jana L Huston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801345160 PECOS PAC ID: 8224318324 Enrollment ID: I20161207001146 |
| Provider Name | Alicia C Layton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053854323 PECOS PAC ID: 2062792062 Enrollment ID: I20161209000024 |
| Provider Name | Angela Massutti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255883674 PECOS PAC ID: 5991085540 Enrollment ID: I20161216002167 |
| Provider Name | Kiran Kumar R Mangalpally |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1558518209 PECOS PAC ID: 1254510878 Enrollment ID: I20170106000806 |
| Provider Name | Mark Richard Stivers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417943523 PECOS PAC ID: 1951386184 Enrollment ID: I20170120002395 |
| Provider Name | Elizabeth Nichole Adkison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225574007 PECOS PAC ID: 3870875792 Enrollment ID: I20170127002387 |
| Provider Name | Sarah T Falcon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629389226 PECOS PAC ID: 6901046010 Enrollment ID: I20170202000719 |
| Provider Name | Kelsie M Mentz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306214697 PECOS PAC ID: 1759687387 Enrollment ID: I20170221002624 |
| Provider Name | Terri Hicok |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316486061 PECOS PAC ID: 7618251570 Enrollment ID: I20170222000108 |
| Provider Name | Elizabeth Pautler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750822474 PECOS PAC ID: 3072899731 Enrollment ID: I20170411002201 |
| Provider Name | Keila M Sierra-contron |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447406368 PECOS PAC ID: 1658599386 Enrollment ID: I20170522000925 |
| Provider Name | John Seccombe |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1922026780 PECOS PAC ID: 8325069214 Enrollment ID: I20170615000273 |
| Provider Name | Mika Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063846467 PECOS PAC ID: 8022244797 Enrollment ID: I20170615000706 |
| Provider Name | Thomas Luft |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659329845 PECOS PAC ID: 7012910789 Enrollment ID: I20170719000364 |
| Provider Name | Anna Weaver Grady |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346653334 PECOS PAC ID: 3870719784 Enrollment ID: I20170727002181 |
| Provider Name | Whitney Mack |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598173403 PECOS PAC ID: 6204157902 Enrollment ID: I20170727003545 |
| Provider Name | Marie-josee S Thibault |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1033168042 PECOS PAC ID: 8426076639 Enrollment ID: I20170728000201 |
| Provider Name | Jose Kuzhively |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295090330 PECOS PAC ID: 8022316397 Enrollment ID: I20170801002804 |
| Provider Name | Justin Lee Fischer |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1730456914 PECOS PAC ID: 0143514331 Enrollment ID: I20170801003819 |
| Provider Name | Noman Shahid |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992111009 PECOS PAC ID: 8123349818 Enrollment ID: I20170803000422 |
| Provider Name | Sarah J Chalmers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740612241 PECOS PAC ID: 8426379355 Enrollment ID: I20170809000854 |
| Provider Name | Cheryl Herrmann |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1063936573 PECOS PAC ID: 9032481486 Enrollment ID: I20170818001709 |
| Provider Name | Jodi Nutter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225566334 PECOS PAC ID: 2365714748 Enrollment ID: I20170818002716 |
| Provider Name | Maria Meschewski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427584259 PECOS PAC ID: 8123390507 Enrollment ID: I20170818002938 |
| Provider Name | David Tennant |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114345584 PECOS PAC ID: 8426321522 Enrollment ID: I20170912002996 |
| Provider Name | Mohsina F Ahmed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568805703 PECOS PAC ID: 4486883824 Enrollment ID: I20170915001909 |
| Provider Name | Taariq Goder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437565561 PECOS PAC ID: 0648590125 Enrollment ID: I20170919000926 |
| Provider Name | Jennifer M Zeck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154845089 PECOS PAC ID: 1456625144 Enrollment ID: I20170919002217 |
| Provider Name | Rachel Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669996781 PECOS PAC ID: 4688948375 Enrollment ID: I20170919002481 |
| Provider Name | Praveen R Anegondhi Sudhindra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225340045 PECOS PAC ID: 5294009502 Enrollment ID: I20170926002361 |
| Provider Name | Michael J Sanders |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1104848332 PECOS PAC ID: 8527037217 Enrollment ID: I20170928000508 |
| Provider Name | Amber Marian Breitzman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275057408 PECOS PAC ID: 0749555852 Enrollment ID: I20170928003774 |
| Provider Name | Nada Farooq |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083020796 PECOS PAC ID: 9133495302 Enrollment ID: I20171017000824 |
| Provider Name | Breanna Regguinti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871002048 PECOS PAC ID: 1254607278 Enrollment ID: I20171019000235 |
| Provider Name | Amy Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659890804 PECOS PAC ID: 3577839505 Enrollment ID: I20171019000497 |
| Provider Name | Valerie Fortier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477062651 PECOS PAC ID: 3375819154 Enrollment ID: I20171023001543 |
| Provider Name | Laura Rachel Jarvis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578081790 PECOS PAC ID: 8921374455 Enrollment ID: I20171027000106 |
| Provider Name | Stacey Herring |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952811259 PECOS PAC ID: 9638435811 Enrollment ID: I20171103000201 |
| Provider Name | Vrushank Patel |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1063737583 PECOS PAC ID: 0648412775 Enrollment ID: I20171110000951 |
| Provider Name | Sarah E Kneip |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790294403 PECOS PAC ID: 9032475645 Enrollment ID: I20171115001945 |
| Provider Name | Jennifer Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992233977 PECOS PAC ID: 7214294297 Enrollment ID: I20171129001891 |
| Provider Name | Olaniyi O Osofisan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1447333554 PECOS PAC ID: 9638156664 Enrollment ID: I20171213000125 |
| Provider Name | Megan Elizabeth Berry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740647965 PECOS PAC ID: 0244533370 Enrollment ID: I20180108000696 |
| Provider Name | Rohit Mehta |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1437339058 PECOS PAC ID: 5991954372 Enrollment ID: I20180118002438 |
| Provider Name | Tammy Burtch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245748920 PECOS PAC ID: 7416217732 Enrollment ID: I20180207000069 |
| Provider Name | Karen Becker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306344650 PECOS PAC ID: 1951662683 Enrollment ID: I20180221000459 |
| Provider Name | Matthew Culp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285142281 PECOS PAC ID: 3870855729 Enrollment ID: I20180313001604 |
| Provider Name | Chidiebere Munachimso Opara |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366823627 PECOS PAC ID: 5092008474 Enrollment ID: I20180322000898 |
| Provider Name | Jamie Beversdorf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427256965 PECOS PAC ID: 2163608605 Enrollment ID: I20180508002353 |
| Provider Name | Jon Soble |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1487639969 PECOS PAC ID: 2365355344 Enrollment ID: I20180517001392 |
| Provider Name | Jessica Schlupp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184113318 PECOS PAC ID: 5890042857 Enrollment ID: I20180720003021 |
| Provider Name | Melinda Bahler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033608872 PECOS PAC ID: 1355699521 Enrollment ID: I20180803000884 |
| Provider Name | Eric L Lo |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1497782023 PECOS PAC ID: 8123193208 Enrollment ID: I20180806002918 |
| Provider Name | Nicholas Robert Grieco |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649657685 PECOS PAC ID: 8921302589 Enrollment ID: I20180816000479 |
| Provider Name | Sheena Mbachu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1225423841 PECOS PAC ID: 3577873249 Enrollment ID: I20180828003032 |
| Provider Name | Kristen Dent |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881072791 PECOS PAC ID: 8527373604 Enrollment ID: I20180829000520 |
| Provider Name | Jennah Siwak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205220597 PECOS PAC ID: 2567768450 Enrollment ID: I20180910000050 |
| Provider Name | Matthew R Sehring |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1629458526 PECOS PAC ID: 0345554085 Enrollment ID: I20180913001568 |
| Provider Name | Leah E Hulse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285117820 PECOS PAC ID: 3779835053 Enrollment ID: I20181015002885 |
| Provider Name | Kevin Dean Spangler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659790350 PECOS PAC ID: 9739404591 Enrollment ID: I20181106000245 |
| Provider Name | Irfan Choudhry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124369855 PECOS PAC ID: 3577860295 Enrollment ID: I20181107001154 |
| Provider Name | Robert Aranson |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1407894728 PECOS PAC ID: 4486613551 Enrollment ID: I20181210001695 |
| Provider Name | Srikanth Markapuram |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720343072 PECOS PAC ID: 2567770589 Enrollment ID: I20190114000214 |
| Provider Name | Ashley M Fischer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1245678135 PECOS PAC ID: 4486992062 Enrollment ID: I20190206000424 |
| Provider Name | Candice Y White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104272079 PECOS PAC ID: 2668710138 Enrollment ID: I20190207000814 |
| Provider Name | Buffi S Oberle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356588099 PECOS PAC ID: 2961740378 Enrollment ID: I20190211001144 |
| Provider Name | Reginald Bowman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1316101892 PECOS PAC ID: 9335487628 Enrollment ID: I20190212001616 |
| Provider Name | Melissa S Catton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164912762 PECOS PAC ID: 6709125180 Enrollment ID: I20190301000317 |
| Provider Name | Andrea Volkerding |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1922412717 PECOS PAC ID: 8527364819 Enrollment ID: I20190305001298 |
| Provider Name | Erik M Shipley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689029027 PECOS PAC ID: 0244572220 Enrollment ID: I20190423000052 |
| Provider Name | Muhammad Deen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841649845 PECOS PAC ID: 5890089346 Enrollment ID: I20190423000599 |
| Provider Name | Shumaila S Masood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245494871 PECOS PAC ID: 9537355391 Enrollment ID: I20190425002666 |
| Provider Name | Kimberly Helmkamp |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1447633128 PECOS PAC ID: 8325354905 Enrollment ID: I20190516000640 |
| Provider Name | Adetoun A Adeyemi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1154784809 PECOS PAC ID: 6406142520 Enrollment ID: I20190626002323 |
| Provider Name | Aimee R Sarchet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508055401 PECOS PAC ID: 0749516367 Enrollment ID: I20190719000744 |
| Provider Name | Abby G Freckleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477113348 PECOS PAC ID: 9032446596 Enrollment ID: I20190807001779 |
| Provider Name | Omomengbe B Oni |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356793459 PECOS PAC ID: 1850685231 Enrollment ID: I20190812000032 |
| Provider Name | Umair Ahmed |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134579402 PECOS PAC ID: 8820380918 Enrollment ID: I20190813002335 |
| Provider Name | Bilal Mohamed |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1669822318 PECOS PAC ID: 8325330509 Enrollment ID: I20190830001717 |
| Provider Name | Dhaval R Save |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659703759 PECOS PAC ID: 3971809245 Enrollment ID: I20190906000924 |
| Provider Name | Natalie E Pedersen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538518923 PECOS PAC ID: 3971896663 Enrollment ID: I20190919002459 |
| Provider Name | Surya Teja Chaturvedula |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1801184767 PECOS PAC ID: 5890008148 Enrollment ID: I20191015002237 |
| Provider Name | Sai Aparna Nelakanti |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1801159165 PECOS PAC ID: 7810200953 Enrollment ID: I20191016000153 |
| Provider Name | Raeda Alshantti |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376092288 PECOS PAC ID: 5597096883 Enrollment ID: I20191017002520 |
| Provider Name | Mary K Franks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871153189 PECOS PAC ID: 2668704628 Enrollment ID: I20191024002897 |
| Provider Name | Cindy R Pettit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750931531 PECOS PAC ID: 0648602789 Enrollment ID: I20191112001210 |
| Provider Name | Lindsey J Lustfeldt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386926525 PECOS PAC ID: 3678905445 Enrollment ID: I20191115002093 |
| Provider Name | Michelle L Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790347722 PECOS PAC ID: 0749612554 Enrollment ID: I20191118000138 |
| Provider Name | Hollie Nicole Hangartner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669015566 PECOS PAC ID: 2961835483 Enrollment ID: I20191213000825 |
| Provider Name | Kalyan Chakravarthy Potu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1861834897 PECOS PAC ID: 8527297704 Enrollment ID: I20191213001345 |
| Provider Name | Ma Benirose Mcnaught |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821645607 PECOS PAC ID: 9335573294 Enrollment ID: I20191231000531 |
| Provider Name | Aaron M Owens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265070494 PECOS PAC ID: 3476981903 Enrollment ID: I20200317001140 |
| Provider Name | Kyle Kiesewetter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598399693 PECOS PAC ID: 6608206735 Enrollment ID: I20200414000094 |
| Provider Name | Christa Jaglinski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588292239 PECOS PAC ID: 1951722230 Enrollment ID: I20200522002493 |
| Provider Name | Bhumik Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689938797 PECOS PAC ID: 8527373711 Enrollment ID: I20200603001298 |
| Provider Name | Katy J Northcutt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609343128 PECOS PAC ID: 1355763939 Enrollment ID: I20200629001040 |
| Provider Name | Jantsen R Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174054415 PECOS PAC ID: 2567733934 Enrollment ID: I20200916001135 |
| Provider Name | Moaviz B Badshah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114466885 PECOS PAC ID: 8729323050 Enrollment ID: I20200929002358 |
| Provider Name | Melissa M Florido |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316473804 PECOS PAC ID: 0042584716 Enrollment ID: I20200930001689 |
| Provider Name | Joseph M Babione |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417575853 PECOS PAC ID: 4082034392 Enrollment ID: I20201026000589 |
| Provider Name | Saqib Walayat |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1649729732 PECOS PAC ID: 2264710128 Enrollment ID: I20201118001384 |
| Provider Name | Austyn E Powers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306443056 PECOS PAC ID: 9638580335 Enrollment ID: I20201202000947 |
| Provider Name | Akash Goel |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1659630192 PECOS PAC ID: 0941552632 Enrollment ID: I20210322000539 |
| Provider Name | Sami Mohammed Abdus |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1801162078 PECOS PAC ID: 4385952746 Enrollment ID: I20210414002034 |
| Provider Name | Rachel Caudle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649877416 PECOS PAC ID: 8921407172 Enrollment ID: I20210520002132 |
| Provider Name | Ian A Martinez Flores |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356821649 PECOS PAC ID: 0345593844 Enrollment ID: I20210802002219 |
| Provider Name | Hillary Kay Watkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932725801 PECOS PAC ID: 5597169730 Enrollment ID: I20210810001352 |
| Provider Name | Asra Rab |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710414438 PECOS PAC ID: 3577837343 Enrollment ID: I20210811000977 |
| Provider Name | Saba Batool |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285112854 PECOS PAC ID: 6709282437 Enrollment ID: I20210907000086 |
| Provider Name | Zahra Ahmad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902218175 PECOS PAC ID: 6901164185 Enrollment ID: I20210920000141 |
| Provider Name | Janice Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861070161 PECOS PAC ID: 7113324799 Enrollment ID: I20210923003287 |
| Provider Name | Karamjit Singh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619330115 PECOS PAC ID: 7911291562 Enrollment ID: I20210927000734 |
| Provider Name | Bazal Ehsan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497242770 PECOS PAC ID: 0749532760 Enrollment ID: I20211001000863 |
| Provider Name | Amanda Harris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871937326 PECOS PAC ID: 7315237302 Enrollment ID: I20211112001195 |
| Provider Name | Breanna Gibbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457010407 PECOS PAC ID: 3375936453 Enrollment ID: I20220214001160 |
| Provider Name | Angela Marie Erickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386303139 PECOS PAC ID: 8325431331 Enrollment ID: I20220215000125 |
| Provider Name | Taylor Jordan Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376128439 PECOS PAC ID: 2466845482 Enrollment ID: I20220215000755 |
| Provider Name | Elaina Molter Shadrach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083118764 PECOS PAC ID: 5597011619 Enrollment ID: I20220216002787 |
| Provider Name | Lauren Rumler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265196091 PECOS PAC ID: 6406240118 Enrollment ID: I20220223000936 |
| Provider Name | Sara Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376191981 PECOS PAC ID: 4789079385 Enrollment ID: I20220317001844 |
| Provider Name | Arvind Reddy Devanabanda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578974069 PECOS PAC ID: 9830449529 Enrollment ID: I20220513000075 |
| Provider Name | Zoe Ortega |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770963258 PECOS PAC ID: 2860742210 Enrollment ID: I20220513002055 |
| Provider Name | Mudassir Ilyas Malik |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1457553653 PECOS PAC ID: 0840362984 Enrollment ID: I20220513002252 |
| Provider Name | Shana Rae Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184214306 PECOS PAC ID: 5496132276 Enrollment ID: I20220517001253 |
| Provider Name | Ramyashree Tummala |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1134502263 PECOS PAC ID: 3072991447 Enrollment ID: I20220526001628 |
| Provider Name | Mina Mecheal Benjamin Mehanni |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1902186166 PECOS PAC ID: 2163664087 Enrollment ID: I20220602001844 |
| Provider Name | Ramprakash Devadoss |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487918017 PECOS PAC ID: 3274869151 Enrollment ID: I20220602002998 |
| Provider Name | Pranitha Kovuri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205489135 PECOS PAC ID: 8022498989 Enrollment ID: I20220708002845 |
| Provider Name | Amanda Dupre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467913194 PECOS PAC ID: 2466832118 Enrollment ID: I20220712001326 |
| Provider Name | Lizabeth Kaeb |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992368096 PECOS PAC ID: 6608257399 Enrollment ID: I20220712003258 |
| Provider Name | Peter Cunningham |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1578112983 PECOS PAC ID: 6608257969 Enrollment ID: I20220718001701 |
| Provider Name | Allison C Brooks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710507892 PECOS PAC ID: 9830565381 Enrollment ID: I20221025000709 |
| Provider Name | Elena Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164041489 PECOS PAC ID: 6800263112 Enrollment ID: I20221028002535 |
| Provider Name | Tushar Acharya |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1922313774 PECOS PAC ID: 3577866995 Enrollment ID: I20221125000219 |
| Provider Name | Shuddhadeb Ray |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1891081055 PECOS PAC ID: 6406085984 Enrollment ID: I20221128001347 |
| Provider Name | Natalie Krier Arreola |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720441686 PECOS PAC ID: 1850658501 Enrollment ID: I20230210001150 |
| Provider Name | Anastasia Nast |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376101840 PECOS PAC ID: 4183959703 Enrollment ID: I20230524002834 |
| Provider Name | Nicholas James Rogers |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164086385 PECOS PAC ID: 8325408651 Enrollment ID: I20230719000421 |
| Provider Name | Samiha Sarkar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1417571001 PECOS PAC ID: 0446676266 Enrollment ID: I20230730000160 |
| Provider Name | Paula Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689201576 PECOS PAC ID: 6709247943 Enrollment ID: I20230803002101 |
| Provider Name | Brandon James Burnett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427730274 PECOS PAC ID: 3476917477 Enrollment ID: I20230908002726 |
| Provider Name | Maria Bertsche |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770271694 PECOS PAC ID: 9436506565 Enrollment ID: I20231113000167 |
| Provider Name | Katherine Every Matulle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851971170 PECOS PAC ID: 5294183596 Enrollment ID: I20231128000191 |
| Provider Name | Bradley Neil Cobb |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356907570 PECOS PAC ID: 7810346269 Enrollment ID: I20231211000735 |
| Provider Name | Liana Sophie Beauchamp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669052544 PECOS PAC ID: 1759726003 Enrollment ID: I20240227002036 |
| Provider Name | Carrie Ann Downing-larick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134749245 PECOS PAC ID: 0941645030 Enrollment ID: I20240228003155 |
Endocrine & Diabetes, Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3308 W Chartwell Rd, Peoria, IL 61614 Phone: 309-691-7640 Fax: 309-691-7640 | |
Orland Park Orthopedics - Peoria Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 W Mcclure Ave, Peoria, IL 61604 Phone: 309-419-8996 Fax: 309-966-3928 | |
Planned Parenthood Of Illinois Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 705 Ne Jefferson St., Peoria, IL 61603 Phone: 309-673-6911 Fax: 309-673-6914 | |
Mjm Family Medicine Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 900 Main St Ste 500, Peoria, IL 61602 Phone: 309-672-4470 Fax: 309-672-4471 | |
Michael D. Cashman, M.d., S.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 900 Main St, Suite 490, Peoria, IL 61602 Phone: 309-671-8313 Fax: 309-671-8740 | |
The Bleeding And Clotting Disorders Institute Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 427 W Northmoor Rd, Peoria, IL 61614 Phone: 309-692-5337 Fax: 309-693-3913 |