| Riverside Health System | |
|
1905 W Court St Kankakee IL 60901-3163 | |
| (815) 935-7526 | |
| (815) 935-7340 |
| Full Name | Riverside Health System |
|---|---|
| Speciality | General Practice |
| Location | 1905 W Court St, Kankakee, Illinois |
| Authorized Official Name and Position | Phillip Kambic (CEO) |
| Authorized Official Contact | 8159331671 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Health System Po Box 781 Kankakee IL 60901-0781 Ph: (815) 935-7526 | Riverside Health System 1905 W Court St Kankakee IL 60901-3163 Ph: (815) 935-7526 |
| NPI Number | 1417061193 |
|---|---|
| Provider Enumeration Date | 08/18/2006 |
| Last Update Date | 12/17/2019 |
| Medicare PECOS PAC ID | 3274434717 |
|---|---|
| Medicare Enrollment ID | O20040116000780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417061193 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Olatunji R Akintilo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760485007 PECOS PAC ID: 9234043282 Enrollment ID: I20031114000289 |
| Provider Name | Asima K Hussaini |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437110970 PECOS PAC ID: 3476545732 Enrollment ID: I20040330000940 |
| Provider Name | Vijay M Haryani |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1487679205 PECOS PAC ID: 3476548173 Enrollment ID: I20040420000778 |
| Provider Name | Borislav Nikolov |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588765317 PECOS PAC ID: 8426044975 Enrollment ID: I20040421001237 |
| Provider Name | Ritu Chandan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710061650 PECOS PAC ID: 5294724142 Enrollment ID: I20040507000167 |
| Provider Name | Maria S Villegas |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1033217104 PECOS PAC ID: 2961491626 Enrollment ID: I20040507001103 |
| Provider Name | Paul E Rowland |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1740246040 PECOS PAC ID: 4082603485 Enrollment ID: I20040511000364 |
| Provider Name | Stonewall Mccuiston |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720072143 PECOS PAC ID: 9638150014 Enrollment ID: I20040609001388 |
| Provider Name | Anne Z Doroba |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1518971167 PECOS PAC ID: 8820073810 Enrollment ID: I20040623000565 |
| Provider Name | Elaine M Papineau |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1417967589 PECOS PAC ID: 1951388420 Enrollment ID: I20040701001487 |
| Provider Name | Karen A Verrill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780684340 PECOS PAC ID: 8224002589 Enrollment ID: I20040823000802 |
| Provider Name | Robert F Boll |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548217466 PECOS PAC ID: 5799750303 Enrollment ID: I20040827000612 |
| Provider Name | Laura M Healy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346277480 PECOS PAC ID: 1557337698 Enrollment ID: I20040909000362 |
| Provider Name | Lynn G Brown |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1013962182 PECOS PAC ID: 6103894787 Enrollment ID: I20040921001086 |
| Provider Name | Zaw Win |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174516579 PECOS PAC ID: 4183683139 Enrollment ID: I20041006000671 |
| Provider Name | Elizabeth D Deck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396715546 PECOS PAC ID: 5395705172 Enrollment ID: I20041015000431 |
| Provider Name | Saroja Yalamanchili |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124077326 PECOS PAC ID: 0143282731 Enrollment ID: I20041027000052 |
| Provider Name | Alyce F Jackson |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1053419119 PECOS PAC ID: 4486617354 Enrollment ID: I20041111000085 |
| Provider Name | Mehmet Sipahi |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1467556837 PECOS PAC ID: 5395706584 Enrollment ID: I20041119001134 |
| Provider Name | Ronald D Curran |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1407867286 PECOS PAC ID: 9638126436 Enrollment ID: I20050404001065 |
| Provider Name | Hilton M Hudson |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1689614828 PECOS PAC ID: 7911984513 Enrollment ID: I20050509000334 |
| Provider Name | Howard I Roth |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043381239 PECOS PAC ID: 1456263011 Enrollment ID: I20050517000965 |
| Provider Name | Dena K Reddick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588763395 PECOS PAC ID: 8820025984 Enrollment ID: I20050722000488 |
| Provider Name | Jasvinder P Chawla |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1952372948 PECOS PAC ID: 1355370578 Enrollment ID: I20050809000077 |
| Provider Name | Charles F Harvey |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1235235938 PECOS PAC ID: 0244264356 Enrollment ID: I20050924000113 |
| Provider Name | Keith A Moss |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588601819 PECOS PAC ID: 4587680137 Enrollment ID: I20051026000380 |
| Provider Name | Juan C Jimenez |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1801992516 PECOS PAC ID: 2365466000 Enrollment ID: I20060120000164 |
| Provider Name | Kendra G Hansen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134230766 PECOS PAC ID: 0547281487 Enrollment ID: I20060126000599 |
| Provider Name | Krystyna D Kiel |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1679549349 PECOS PAC ID: 9638181795 Enrollment ID: I20060608000256 |
| Provider Name | Syed M Hussain |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1245264324 PECOS PAC ID: 1557364494 Enrollment ID: I20060816000132 |
| Provider Name | Raymond G Maceren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891706503 PECOS PAC ID: 2860497955 Enrollment ID: I20060925000046 |
| Provider Name | Kirsten L Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053460634 PECOS PAC ID: 1557363587 Enrollment ID: I20070205000392 |
| Provider Name | Jeffery P Mendell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629285556 PECOS PAC ID: 1759481625 Enrollment ID: I20070706000032 |
| Provider Name | Mobolaji B Suleiman |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1184764086 PECOS PAC ID: 4082650585 Enrollment ID: I20080118000040 |
| Provider Name | Arun Jagannathan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891817961 PECOS PAC ID: 3173618105 Enrollment ID: I20080623000205 |
| Provider Name | Annabelle A Veerapaneni |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1407025208 PECOS PAC ID: 5890862890 Enrollment ID: I20080917000141 |
| Provider Name | Madhu L Sharma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437326238 PECOS PAC ID: 8426126111 Enrollment ID: I20081008000279 |
| Provider Name | Jason L Serpe |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1578660593 PECOS PAC ID: 5395804868 Enrollment ID: I20081112000845 |
| Provider Name | Daniel Orozco |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154329399 PECOS PAC ID: 9537221957 Enrollment ID: I20081218000729 |
| Provider Name | Bruce Dodt |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013059005 PECOS PAC ID: 8022911676 Enrollment ID: I20081230000398 |
| Provider Name | Ryan Jacob Meiners |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295791515 PECOS PAC ID: 5193736502 Enrollment ID: I20090310000573 |
| Provider Name | Jana M Wahlen |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1861631525 PECOS PAC ID: 9739246398 Enrollment ID: I20090325000749 |
| Provider Name | Niby Mathew |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184869125 PECOS PAC ID: 0648320671 Enrollment ID: I20090611000727 |
| Provider Name | Sanjay Chatrath |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861591711 PECOS PAC ID: 2860542735 Enrollment ID: I20090616000026 |
| Provider Name | Jennifer L Maschmann |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1023021433 PECOS PAC ID: 6800948605 Enrollment ID: I20090708000524 |
| Provider Name | Brad L Suprenant |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1760467377 PECOS PAC ID: 1355254665 Enrollment ID: I20090714000624 |
| Provider Name | Naresh C Chandan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811094550 PECOS PAC ID: 7810041290 Enrollment ID: I20090827000637 |
| Provider Name | Ming Hung |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1194730267 PECOS PAC ID: 6709810203 Enrollment ID: I20091217000151 |
| Provider Name | Raju Z Abraham |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1003830852 PECOS PAC ID: 0042354169 Enrollment ID: I20100212000416 |
| Provider Name | Douglas J Morr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548371537 PECOS PAC ID: 7618011081 Enrollment ID: I20100224000302 |
| Provider Name | Ahamed Vp Kutty |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1881624054 PECOS PAC ID: 0244233740 Enrollment ID: I20100305000048 |
| Provider Name | Steven D Williams |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1255426169 PECOS PAC ID: 5890701882 Enrollment ID: I20100416000060 |
| Provider Name | Mary E Belford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194719534 PECOS PAC ID: 9830226257 Enrollment ID: I20100416000068 |
| Provider Name | Astrid B Herard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255598512 PECOS PAC ID: 0345435186 Enrollment ID: I20101105001343 |
| Provider Name | Vikas K Patel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1235349598 PECOS PAC ID: 2668667510 Enrollment ID: I20101117000662 |
| Provider Name | Joehar Hamdan |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1508062159 PECOS PAC ID: 8123214954 Enrollment ID: I20101118001396 |
| Provider Name | Roy E Jonas |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760582316 PECOS PAC ID: 0143416412 Enrollment ID: I20101129000612 |
| Provider Name | Joanne M Leahy Auer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1548369317 PECOS PAC ID: 6608063763 Enrollment ID: I20101215000545 |
| Provider Name | Jimmy Viet Ninh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1104088939 PECOS PAC ID: 6608913835 Enrollment ID: I20110204000220 |
| Provider Name | Julie A Sieling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568766764 PECOS PAC ID: 1850574484 Enrollment ID: I20110319000084 |
| Provider Name | Taruna J Madhav Crawford |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1487865788 PECOS PAC ID: 7911180955 Enrollment ID: I20110329000114 |
| Provider Name | Jennifer L Fitzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265751838 PECOS PAC ID: 2961686340 Enrollment ID: I20110408000415 |
| Provider Name | Ahsan Basha |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1043283849 PECOS PAC ID: 7719961903 Enrollment ID: I20110415000514 |
| Provider Name | Paula E Blair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922307917 PECOS PAC ID: 6406032994 Enrollment ID: I20110518000250 |
| Provider Name | Nha T Huynh |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1376709758 PECOS PAC ID: 3375720899 Enrollment ID: I20110610000238 |
| Provider Name | Angela M Heldt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245537943 PECOS PAC ID: 3375715790 Enrollment ID: I20111007000163 |
| Provider Name | Georgina G Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386918597 PECOS PAC ID: 8426211525 Enrollment ID: I20120530000507 |
| Provider Name | Rachel N Shell |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1942339932 PECOS PAC ID: 5799800934 Enrollment ID: I20120530000592 |
| Provider Name | Nadeem Ansari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073651808 PECOS PAC ID: 4587567136 Enrollment ID: I20120606000036 |
| Provider Name | Thomas A Wroblewski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891833612 PECOS PAC ID: 5799949590 Enrollment ID: I20120607000034 |
| Provider Name | Lizy Andrews |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1831218577 PECOS PAC ID: 4385735364 Enrollment ID: I20120724001007 |
| Provider Name | Federico Herrera |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881926913 PECOS PAC ID: 4183870967 Enrollment ID: I20120809000822 |
| Provider Name | Sinan Simsir |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1528142445 PECOS PAC ID: 5698728889 Enrollment ID: I20130218000425 |
| Provider Name | Gail M Marich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255678751 PECOS PAC ID: 2961647813 Enrollment ID: I20130325000075 |
| Provider Name | Jennifer M Powell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124131966 PECOS PAC ID: 9931345832 Enrollment ID: I20130419000372 |
| Provider Name | Cynthia Decamp Croyle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184942104 PECOS PAC ID: 2466699475 Enrollment ID: I20130511000085 |
| Provider Name | Deanna Schroeder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265523906 PECOS PAC ID: 3476790262 Enrollment ID: I20130515000456 |
| Provider Name | Karla R Schweigert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568708667 PECOS PAC ID: 7517106826 Enrollment ID: I20130618000399 |
| Provider Name | Danielle M. Ratazak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023353844 PECOS PAC ID: 6305085341 Enrollment ID: I20130624000084 |
| Provider Name | Rick Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821337437 PECOS PAC ID: 5799924767 Enrollment ID: I20130624000410 |
| Provider Name | Firas M Sibai |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1194987032 PECOS PAC ID: 9739321522 Enrollment ID: I20130807000225 |
| Provider Name | Mehee Choi |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1659519478 PECOS PAC ID: 5597908293 Enrollment ID: I20130828000536 |
| Provider Name | Lynn Renee Lochner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801238282 PECOS PAC ID: 1557344702 Enrollment ID: I20131106001546 |
| Provider Name | Kenneth Munnerlyn |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1316172513 PECOS PAC ID: 8921246786 Enrollment ID: I20131220001768 |
| Provider Name | Samrat Khanna |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053629881 PECOS PAC ID: 7416185905 Enrollment ID: I20140107001375 |
| Provider Name | Jennifer L Dole |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1376892398 PECOS PAC ID: 3971731340 Enrollment ID: I20140109000792 |
| Provider Name | Mandi A Troli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346677895 PECOS PAC ID: 4880822121 Enrollment ID: I20140114000779 |
| Provider Name | Barbara Bunton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750710612 PECOS PAC ID: 6103054051 Enrollment ID: I20140122001513 |
| Provider Name | Jessica Heather Kellett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356770960 PECOS PAC ID: 2365670239 Enrollment ID: I20140123000226 |
| Provider Name | Kathryn J Hamblen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740615145 PECOS PAC ID: 4183855612 Enrollment ID: I20140327000396 |
| Provider Name | Janella Schroeder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851721948 PECOS PAC ID: 8820221070 Enrollment ID: I20140424000300 |
| Provider Name | Wendy A Dyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770903635 PECOS PAC ID: 8921221797 Enrollment ID: I20140523000243 |
| Provider Name | Donald Graves |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1841579471 PECOS PAC ID: 4587880661 Enrollment ID: I20140725001152 |
| Provider Name | Roselle Almeida |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1720243645 PECOS PAC ID: 7113145186 Enrollment ID: I20140904001750 |
| Provider Name | Jonathan C Cotton |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1023273901 PECOS PAC ID: 8628298601 Enrollment ID: I20140926000782 |
| Provider Name | Syeda Ali |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861770679 PECOS PAC ID: 0547491235 Enrollment ID: I20140926001447 |
| Provider Name | Jessica M Nicholson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033435557 PECOS PAC ID: 7517187750 Enrollment ID: I20141009002319 |
| Provider Name | Erin Dean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316335870 PECOS PAC ID: 4284958273 Enrollment ID: I20150122001048 |
| Provider Name | Tammie O Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598164303 PECOS PAC ID: 0941529689 Enrollment ID: I20150501000491 |
| Provider Name | Vanessa Capps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336429588 PECOS PAC ID: 0345569679 Enrollment ID: I20150507001052 |
| Provider Name | Akta S Kakodkar |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1053622928 PECOS PAC ID: 3870807142 Enrollment ID: I20150730011750 |
| Provider Name | Keyoma Jamerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790105195 PECOS PAC ID: 0143535773 Enrollment ID: I20150812006240 |
| Provider Name | Ashton N Forsythe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942677984 PECOS PAC ID: 8921316365 Enrollment ID: I20151005000359 |
| Provider Name | Melissa K Shepherd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760850531 PECOS PAC ID: 3274841655 Enrollment ID: I20151005001708 |
| Provider Name | Jenna Marie Cella |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942541149 PECOS PAC ID: 6103136015 Enrollment ID: I20151105000450 |
| Provider Name | Lori Cornelius |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275906828 PECOS PAC ID: 8921318569 Enrollment ID: I20151110002410 |
| Provider Name | Brenda Lamping |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962647891 PECOS PAC ID: 0840356689 Enrollment ID: I20151120000696 |
| Provider Name | Katie G Kasper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790155836 PECOS PAC ID: 8224339890 Enrollment ID: I20151228000208 |
| Provider Name | Danielle Marie Valentino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144694639 PECOS PAC ID: 4587969514 Enrollment ID: I20160229001708 |
| Provider Name | Barbara Deyoung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891153888 PECOS PAC ID: 2668778705 Enrollment ID: I20160315002796 |
| Provider Name | Sarah Coyne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073979654 PECOS PAC ID: 0143527119 Enrollment ID: I20160318001649 |
| Provider Name | Pamela Cook |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932506458 PECOS PAC ID: 5799083291 Enrollment ID: I20160418000955 |
| Provider Name | Sarah A Bojak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831550417 PECOS PAC ID: 7315246428 Enrollment ID: I20160425000600 |
| Provider Name | Therese Heenan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467668285 PECOS PAC ID: 0446390025 Enrollment ID: I20160428001025 |
| Provider Name | Christina M Mitsdarffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639530298 PECOS PAC ID: 8123327822 Enrollment ID: I20160502001437 |
| Provider Name | Tahreer Shatat |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245677749 PECOS PAC ID: 0143446534 Enrollment ID: I20160804000590 |
| Provider Name | Leslie Wilbanks |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154550994 PECOS PAC ID: 3476779794 Enrollment ID: I20160809002560 |
| Provider Name | Annette Bennett-otto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073067583 PECOS PAC ID: 1658667779 Enrollment ID: I20160915001080 |
| Provider Name | Bhupinder Paul Khaper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700228947 PECOS PAC ID: 2567698657 Enrollment ID: I20160919001806 |
| Provider Name | Gretchen Williams |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659663581 PECOS PAC ID: 0143517151 Enrollment ID: I20160919002554 |
| Provider Name | Amit Zachariah |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1295964872 PECOS PAC ID: 9537398219 Enrollment ID: I20161013000363 |
| Provider Name | Kaitlain Cavender |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699221374 PECOS PAC ID: 0143508259 Enrollment ID: I20161025000650 |
| Provider Name | Angel White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710340658 PECOS PAC ID: 2466759733 Enrollment ID: I20161114000994 |
| Provider Name | Neelie Panozzo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174976286 PECOS PAC ID: 8820377872 Enrollment ID: I20161115000001 |
| Provider Name | Jeffrey Brown |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1629092937 PECOS PAC ID: 0345217014 Enrollment ID: I20161209000060 |
| Provider Name | Kristen Yunker Mars |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568993962 PECOS PAC ID: 3577840701 Enrollment ID: I20170426000012 |
| Provider Name | Christin M Hoffner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780123091 PECOS PAC ID: 6709163983 Enrollment ID: I20170426002108 |
| Provider Name | Grazelda Kwakye-ackah |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1972949584 PECOS PAC ID: 3678717642 Enrollment ID: I20170427000136 |
| Provider Name | Shambre Chambers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992246763 PECOS PAC ID: 8527345180 Enrollment ID: I20170508002735 |
| Provider Name | Shannon Greenquist |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174062368 PECOS PAC ID: 8224305198 Enrollment ID: I20170524001595 |
| Provider Name | Joi Bradshaw |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1164404281 PECOS PAC ID: 2769415181 Enrollment ID: I20170601000846 |
| Provider Name | Shashvat Sukhal |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1275821878 PECOS PAC ID: 3577869510 Enrollment ID: I20170609000337 |
| Provider Name | Naila A Oconnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114453768 PECOS PAC ID: 3779851787 Enrollment ID: I20170615002214 |
| Provider Name | N'djamina Angelika Robinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821416587 PECOS PAC ID: 3779883509 Enrollment ID: I20170615002627 |
| Provider Name | Ami S Vaidya |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1346534773 PECOS PAC ID: 3971875485 Enrollment ID: I20170817003937 |
| Provider Name | Mohammed Ahmed |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1053623868 PECOS PAC ID: 4981906344 Enrollment ID: I20170908001532 |
| Provider Name | Khalid Arshad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306259817 PECOS PAC ID: 7911271952 Enrollment ID: I20170914002575 |
| Provider Name | Alex Cichomska Herskovic |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1093069528 PECOS PAC ID: 4587935507 Enrollment ID: I20171009000042 |
| Provider Name | Nicholas Guastalli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275957334 PECOS PAC ID: 5698040889 Enrollment ID: I20171016000362 |
| Provider Name | Walter G Rooney |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1518981752 PECOS PAC ID: 5991761058 Enrollment ID: I20171024000290 |
| Provider Name | Raunak Sunil Khisty |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558620146 PECOS PAC ID: 8921310780 Enrollment ID: I20171106003028 |
| Provider Name | Sarah M Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467962621 PECOS PAC ID: 6709142219 Enrollment ID: I20171115002400 |
| Provider Name | Brittani Ann Seagren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467961326 PECOS PAC ID: 0244597102 Enrollment ID: I20171130001921 |
| Provider Name | Richard Jeffery Curren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891133005 PECOS PAC ID: 1850686825 Enrollment ID: I20171219002830 |
| Provider Name | Sana Hussain Qureshi |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1639444375 PECOS PAC ID: 2860751104 Enrollment ID: I20180112002340 |
| Provider Name | Tara A. Campo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144737123 PECOS PAC ID: 7113286881 Enrollment ID: I20180125003187 |
| Provider Name | Josefina Batista |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1316388796 PECOS PAC ID: 2163728726 Enrollment ID: I20180208001384 |
| Provider Name | Margarita Aurelia Mankus |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184035578 PECOS PAC ID: 3173833191 Enrollment ID: I20180209000768 |
| Provider Name | Tu Cao |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316238736 PECOS PAC ID: 1850651936 Enrollment ID: I20180209001570 |
| Provider Name | Hani R Malone |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1285945162 PECOS PAC ID: 5991073058 Enrollment ID: I20180222002183 |
| Provider Name | Shannon K Male |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396246401 PECOS PAC ID: 5496017022 Enrollment ID: I20180320001240 |
| Provider Name | Melissa Ewert Ortega |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407357148 PECOS PAC ID: 4981967940 Enrollment ID: I20180405000128 |
| Provider Name | Abhimanyu Beri |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1336339381 PECOS PAC ID: 3476727348 Enrollment ID: I20180502000509 |
| Provider Name | Timothy G Yovankin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780002360 PECOS PAC ID: 1052668373 Enrollment ID: I20180718001420 |
| Provider Name | Timothy Warren Damrow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225418981 PECOS PAC ID: 4385917798 Enrollment ID: I20180719002152 |
| Provider Name | Natalie A Palka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538653894 PECOS PAC ID: 0345597399 Enrollment ID: I20180720002600 |
| Provider Name | Kimberly K White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588156152 PECOS PAC ID: 6406103480 Enrollment ID: I20180723000702 |
| Provider Name | Jena C Nowicki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558852699 PECOS PAC ID: 0143578948 Enrollment ID: I20180810001631 |
| Provider Name | Shiva Prasad Shashidharan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1588911333 PECOS PAC ID: 3173837895 Enrollment ID: I20180824000246 |
| Provider Name | Amber J Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356888689 PECOS PAC ID: 7214287937 Enrollment ID: I20180830000690 |
| Provider Name | Marisa M Schrum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235618927 PECOS PAC ID: 4385994524 Enrollment ID: I20180910000019 |
| Provider Name | Andrew C Toftoy |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1710246905 PECOS PAC ID: 1759686983 Enrollment ID: I20180913001360 |
| Provider Name | Melissa Rosenow Delioglou |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659717437 PECOS PAC ID: 8628329190 Enrollment ID: I20180921001452 |
| Provider Name | April A Szafran |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1194015503 PECOS PAC ID: 1951672203 Enrollment ID: I20181012000936 |
| Provider Name | Jessica S Shin |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1578820775 PECOS PAC ID: 9739484965 Enrollment ID: I20181012001316 |
| Provider Name | Joshua Devereux Miller |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1225114663 PECOS PAC ID: 1153674650 Enrollment ID: I20181031000987 |
| Provider Name | Ashley N Perreault |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033699509 PECOS PAC ID: 0446503668 Enrollment ID: I20181105001619 |
| Provider Name | Cheryl Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477062172 PECOS PAC ID: 2567716681 Enrollment ID: I20181108000555 |
| Provider Name | Jenna Nicole Sarna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104393180 PECOS PAC ID: 9133463383 Enrollment ID: I20181129001166 |
| Provider Name | Sarah Nicole Leveque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649755109 PECOS PAC ID: 8426393679 Enrollment ID: I20181217002806 |
| Provider Name | Nicholas Brandl Rossi |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1295029510 PECOS PAC ID: 5294972816 Enrollment ID: I20190128001249 |
| Provider Name | Kristin Michelle Cyrier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922571397 PECOS PAC ID: 9739429366 Enrollment ID: I20190319001148 |
| Provider Name | Alok M Patel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1457627465 PECOS PAC ID: 5092061788 Enrollment ID: I20190405001793 |
| Provider Name | Kaitlyn Ruckman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306310131 PECOS PAC ID: 2062753452 Enrollment ID: I20190412000264 |
| Provider Name | Kristal Maureen Kunitomo Brown |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1326363656 PECOS PAC ID: 8628391794 Enrollment ID: I20190412001065 |
| Provider Name | Lindsey Michelle Dockemeyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881154649 PECOS PAC ID: 4981946233 Enrollment ID: I20190507001049 |
| Provider Name | Vidita Khatri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588072292 PECOS PAC ID: 8123314572 Enrollment ID: I20190531000385 |
| Provider Name | Ahmad Zafar Chaudhry |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1144304635 PECOS PAC ID: 0547386849 Enrollment ID: I20190703002396 |
| Provider Name | Michael Robert Ruebhausen |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1942649819 PECOS PAC ID: 0648574343 Enrollment ID: I20190718000794 |
| Provider Name | Naga Pushpa Guntupalli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518340231 PECOS PAC ID: 9739493347 Enrollment ID: I20190718002564 |
| Provider Name | Safi Mohammed |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1891100889 PECOS PAC ID: 5193044816 Enrollment ID: I20190719001228 |
| Provider Name | Mayurika Pise |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811383334 PECOS PAC ID: 5193025104 Enrollment ID: I20190722001139 |
| Provider Name | Issra A Rashed |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1891045431 PECOS PAC ID: 2163641317 Enrollment ID: I20190725001469 |
| Provider Name | Kathryn E Vela |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043558265 PECOS PAC ID: 0840435962 Enrollment ID: I20190730004415 |
| Provider Name | Faizan Bader |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1144674706 PECOS PAC ID: 2567798317 Enrollment ID: I20190731002633 |
| Provider Name | Morgan Taylor Willbarger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780141234 PECOS PAC ID: 3173851771 Enrollment ID: I20190820004017 |
| Provider Name | Mohammad Abdelhafez Issa |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1033539630 PECOS PAC ID: 4688902562 Enrollment ID: I20190830000876 |
| Provider Name | Kshiti Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609437268 PECOS PAC ID: 5193054260 Enrollment ID: I20190916001211 |
| Provider Name | Katherine Anne Van Hoveln |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538720008 PECOS PAC ID: 6002146974 Enrollment ID: I20190919003227 |
| Provider Name | Ekua Baidua Gilbert-baffoe |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1275952913 PECOS PAC ID: 1153669262 Enrollment ID: I20190926001793 |
| Provider Name | Kelly Christine White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508427949 PECOS PAC ID: 8022349091 Enrollment ID: I20191007002087 |
| Provider Name | Marissa Nicole Ruebhausen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962994483 PECOS PAC ID: 5597097030 Enrollment ID: I20191101000931 |
| Provider Name | Michael Meng Chen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558757757 PECOS PAC ID: 9335424449 Enrollment ID: I20191210002786 |
| Provider Name | Tapan Ravindra Kavi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780008748 PECOS PAC ID: 9931413804 Enrollment ID: I20191217000585 |
| Provider Name | Quantel Valdezzel Rolle |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1700204583 PECOS PAC ID: 4981038270 Enrollment ID: I20191219000359 |
| Provider Name | Ruchir Shah |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396033437 PECOS PAC ID: 1557656501 Enrollment ID: I20191223000858 |
| Provider Name | Rajiv Narula |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1982959979 PECOS PAC ID: 6709147689 Enrollment ID: I20191223001027 |
| Provider Name | Neeraj Singh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1194160457 PECOS PAC ID: 6709136443 Enrollment ID: I20191227000016 |
| Provider Name | Elizabeth Wirth |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1245758416 PECOS PAC ID: 1759715758 Enrollment ID: I20191230000002 |
| Provider Name | Holly Koren Dinello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548808959 PECOS PAC ID: 2769818681 Enrollment ID: I20200212000757 |
| Provider Name | Joanna L Lambert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659775534 PECOS PAC ID: 6002126117 Enrollment ID: I20200313001329 |
| Provider Name | Nasir Fakhri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1104204502 PECOS PAC ID: 3476869256 Enrollment ID: I20200427000861 |
| Provider Name | Shana Marie Teske |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811521883 PECOS PAC ID: 5395176747 Enrollment ID: I20200519001058 |
| Provider Name | Stefanie Ann Lem |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629567185 PECOS PAC ID: 4587085857 Enrollment ID: I20200522002015 |
| Provider Name | Krista Rose Barton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144854373 PECOS PAC ID: 6204259336 Enrollment ID: I20200708002661 |
| Provider Name | Shuja Sheikh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811383755 PECOS PAC ID: 4385977321 Enrollment ID: I20200713001646 |
| Provider Name | Bushra A Alam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083134118 PECOS PAC ID: 7911242482 Enrollment ID: I20200722002710 |
| Provider Name | Kathryn Margaret Marie Inczaukskis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356979629 PECOS PAC ID: 5799109740 Enrollment ID: I20200723000171 |
| Provider Name | Tarun Jain |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1316289077 PECOS PAC ID: 8527290105 Enrollment ID: I20200801000020 |
| Provider Name | Janos Antal Uzonyi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912357070 PECOS PAC ID: 0446675870 Enrollment ID: I20200803001191 |
| Provider Name | Rubina Siddiq Baig |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659809879 PECOS PAC ID: 3577831239 Enrollment ID: I20200807001840 |
| Provider Name | Lena Khaled Alia |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578926143 PECOS PAC ID: 6002232311 Enrollment ID: I20200818001045 |
| Provider Name | Michael Gambla |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1952367641 PECOS PAC ID: 8628049921 Enrollment ID: I20201005002407 |
| Provider Name | Alicia N Kendra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467069823 PECOS PAC ID: 0042621302 Enrollment ID: I20201118001413 |
| Provider Name | Krish Jay Miglani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598293920 PECOS PAC ID: 6204105109 Enrollment ID: I20201223001603 |
| Provider Name | Caitlin Mccarthy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750990271 PECOS PAC ID: 7618381260 Enrollment ID: I20210122001583 |
| Provider Name | Mary Brandenburg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003394024 PECOS PAC ID: 0648521096 Enrollment ID: I20210125001221 |
| Provider Name | Maryann L Kelly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033640206 PECOS PAC ID: 9436429537 Enrollment ID: I20210125001894 |
| Provider Name | Jason Shin |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1699229435 PECOS PAC ID: 1254746456 Enrollment ID: I20210222001696 |
| Provider Name | Tara Lynn Barnes-cherry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104424068 PECOS PAC ID: 7113335977 Enrollment ID: I20210415000303 |
| Provider Name | Kelly Rhodes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639691090 PECOS PAC ID: 6103235320 Enrollment ID: I20210429000459 |
| Provider Name | Olatola Iyi-ojo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477074060 PECOS PAC ID: 0840557807 Enrollment ID: I20210629000066 |
| Provider Name | Ximena Morales |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1477537256 PECOS PAC ID: 9739159039 Enrollment ID: I20210708001653 |
| Provider Name | Lisa Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154810778 PECOS PAC ID: 3375891930 Enrollment ID: I20210719003436 |
| Provider Name | Andrea Dunn Baldwin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992374730 PECOS PAC ID: 9032512835 Enrollment ID: I20210729003930 |
| Provider Name | Swati Laroia Coon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306284765 PECOS PAC ID: 8224255492 Enrollment ID: I20210813001487 |
| Provider Name | Seban Liu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174904304 PECOS PAC ID: 8729359856 Enrollment ID: I20210813001686 |
| Provider Name | Kyle Yuichi Ogami |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801276571 PECOS PAC ID: 9638471626 Enrollment ID: I20210830000463 |
| Provider Name | Hamzeh O Badwan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205333994 PECOS PAC ID: 4385990464 Enrollment ID: I20211005001102 |
| Provider Name | Keith Buza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639846173 PECOS PAC ID: 6608274402 Enrollment ID: I20211008001114 |
| Provider Name | Steven Groene |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1407175318 PECOS PAC ID: 4880832005 Enrollment ID: I20211026000260 |
| Provider Name | Isabel Montoya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487286886 PECOS PAC ID: 4385052208 Enrollment ID: I20211118000977 |
| Provider Name | Ahmed Abdelkader |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1578912572 PECOS PAC ID: 9537582416 Enrollment ID: I20211129001475 |
| Provider Name | Ramanpreet Grewal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407339286 PECOS PAC ID: 9436540671 Enrollment ID: I20211227000329 |
| Provider Name | Mihir Milind Joshi |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1760844179 PECOS PAC ID: 4385047257 Enrollment ID: I20220203001421 |
| Provider Name | Mary Moore |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1629321229 PECOS PAC ID: 5991614612 Enrollment ID: I20220222002380 |
| Provider Name | Jehad Zakaria |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1225455181 PECOS PAC ID: 3577942283 Enrollment ID: I20220625000312 |
| Provider Name | Reid Thomas Alley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568956043 PECOS PAC ID: 2860873510 Enrollment ID: I20220713001065 |
| Provider Name | Jabiz Anahita Behzadpour |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1407381171 PECOS PAC ID: 2264862697 Enrollment ID: I20220721001317 |
| Provider Name | Yuri Zermeno |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1003310186 PECOS PAC ID: 7012399280 Enrollment ID: I20220804000781 |
| Provider Name | Yetunde Akinde |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1033616198 PECOS PAC ID: 5395092746 Enrollment ID: I20220805002457 |
| Provider Name | Nathan Lewis Frogge |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1982017943 PECOS PAC ID: 0244455590 Enrollment ID: I20220811000672 |
| Provider Name | Jessica Alston |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1922458405 PECOS PAC ID: 8426340704 Enrollment ID: I20220921003784 |
| Provider Name | Melanie Winningham |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588954788 PECOS PAC ID: 9335434752 Enrollment ID: I20220924000337 |
| Provider Name | Ada Wang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952757973 PECOS PAC ID: 4981982279 Enrollment ID: I20221018000360 |
| Provider Name | Elizabeth Chase |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487374682 PECOS PAC ID: 1254708613 Enrollment ID: I20221028000268 |
| Provider Name | Christina M Lineback |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1922539600 PECOS PAC ID: 5294070868 Enrollment ID: I20221116002814 |
| Provider Name | Riccardo Autorino |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1033499116 PECOS PAC ID: 9436376878 Enrollment ID: I20221202000698 |
| Provider Name | Cassandra Lacher |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1467746651 PECOS PAC ID: 6608098306 Enrollment ID: I20230109000266 |
| Provider Name | Jennie Marie Strezo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831829894 PECOS PAC ID: 7214308816 Enrollment ID: I20230118001897 |
| Provider Name | Miranda Sirvinskas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083336861 PECOS PAC ID: 1153793534 Enrollment ID: I20230213000662 |
| Provider Name | Crystal Monique Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528780392 PECOS PAC ID: 5294108056 Enrollment ID: I20230227002521 |
| Provider Name | Kendra Ann Pauley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720792617 PECOS PAC ID: 6204201742 Enrollment ID: I20230414000048 |
| Provider Name | Patricia Joan Croix |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1891964649 PECOS PAC ID: 7517322118 Enrollment ID: I20230504001011 |
| Provider Name | Rosvida Anne B. San Gabriel |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023166535 PECOS PAC ID: 7214393784 Enrollment ID: I20230525002659 |
| Provider Name | Jenna English |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699486407 PECOS PAC ID: 9032576285 Enrollment ID: I20230605000823 |
| Provider Name | Aline V Dang |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1316394430 PECOS PAC ID: 1759748874 Enrollment ID: I20230606000747 |
| Provider Name | Ishita Jain |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1427581370 PECOS PAC ID: 0840617692 Enrollment ID: I20230627001148 |
| Provider Name | Stephen Patrick Supple |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225565054 PECOS PAC ID: 0244501740 Enrollment ID: I20230701000362 |
| Provider Name | Vivek Vankayala Reddy |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1396131835 PECOS PAC ID: 9234435660 Enrollment ID: I20230706000245 |
| Provider Name | Sara Elizabeth Yap |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1225514334 PECOS PAC ID: 0345593034 Enrollment ID: I20230710001014 |
| Provider Name | Alex Rugino |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1730458316 PECOS PAC ID: 7315114113 Enrollment ID: I20230810004352 |
| Provider Name | Vaishak Amblee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861923534 PECOS PAC ID: 7911277587 Enrollment ID: I20230816002438 |
| Provider Name | Ashraf A Uddin |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1699262782 PECOS PAC ID: 3375946742 Enrollment ID: I20230824002326 |
| Provider Name | Chanel Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245928589 PECOS PAC ID: 8820451313 Enrollment ID: I20230831000823 |
| Provider Name | Israr Ul Haq |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164910899 PECOS PAC ID: 9739543927 Enrollment ID: I20230906002362 |
| Provider Name | Naomi Irene Lerner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457994030 PECOS PAC ID: 8527429513 Enrollment ID: I20231011002914 |
| Provider Name | Dhara H Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841815610 PECOS PAC ID: 4284089939 Enrollment ID: I20231016001974 |
| Provider Name | David Orin Cherry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427737659 PECOS PAC ID: 8921454430 Enrollment ID: I20231019001477 |
| Provider Name | Dexter Odeneal |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1063060689 PECOS PAC ID: 5395192603 Enrollment ID: I20231108001418 |
| Provider Name | Jeremiah Fuller Bell |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1639533870 PECOS PAC ID: 0244524338 Enrollment ID: I20231201001258 |
| Provider Name | Katherine Marie Leclear |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093597791 PECOS PAC ID: 3072963198 Enrollment ID: I20240102000769 |
| Provider Name | Afton Kay Swanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639951031 PECOS PAC ID: 3274986799 Enrollment ID: I20240131001945 |
| Provider Name | Ann Collier |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487898458 PECOS PAC ID: 0042442915 Enrollment ID: I20240209001814 |
| Provider Name | Jessica Norman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104687904 PECOS PAC ID: 3779928908 Enrollment ID: I20240228000484 |
Sound Physicians Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 350 N Wall St, Kankakee, IL 60901 Phone: 815-933-1671 | |
Med-peds Associates,p.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 375 N Wall St, Ste P520, Kankakee, IL 60901 Phone: 815-933-0194 Fax: 815-933-1444 | |
Misbah Uddin Ahmed Md Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 555 W Court St, Ste 200, Kankakee, IL 60901 Phone: 815-935-2525 Fax: 815-935-1010 | |
Hippocrates Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 155 S Schuyler Ave, Kankakee, IL 60901 Phone: 708-446-4102 | |
Peace Of Mind Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 995 N Kennedy Dr, Kankakee, IL 60901 Phone: 815-450-7100 Fax: 815-304-4415 | |
Khs School-based Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1200 W Jeffery St, Kankakee, IL 60901 Phone: 815-933-0690 Fax: 815-933-6704 | |
New Life Education Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1701 E Court St., Kankakee, IL 60901 Phone: 815-935-5433 Fax: 815-935-1187 |