| 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 |
| Certification 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 | () | 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 | Donatas a Siliunas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548261910 PECOS PAC ID: 4789589359 Enrollment ID: I20031211000621 |
| Provider Name | Tarek Ahdab |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1184849747 PECOS PAC ID: 8820996903 Enrollment ID: I20031229000156 |
| Provider Name | Evan Samett |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1306890728 PECOS PAC ID: 8921992991 Enrollment ID: I20040211000038 |
| 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 | 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 | 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 | Tina Barber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023078367 PECOS PAC ID: 9830159953 Enrollment ID: I20041013000926 |
| 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 | Mehmet Sipahi |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1467556837 PECOS PAC ID: 5395706584 Enrollment ID: I20041119001134 |
| Provider Name | Steven R Klepac |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265416002 PECOS PAC ID: 9133172018 Enrollment ID: I20050303000090 |
| Provider Name | Hilton 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 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 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 | Shyam K Prabhakaran |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1700815818 PECOS PAC ID: 8921063512 Enrollment ID: I20060908000194 |
| Provider Name | Raymond G Maceren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891706503 PECOS PAC ID: 2860497955 Enrollment ID: I20060925000046 |
| Provider Name | Sherri Beth Morrison |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1285738500 PECOS PAC ID: 6002812765 Enrollment ID: I20061020000109 |
| Provider Name | Jonathan E Jusko |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1558431783 PECOS PAC ID: 5991703142 Enrollment ID: I20061122000066 |
| Provider Name | Suveer B Tatineni |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275579401 PECOS PAC ID: 3577563659 Enrollment ID: I20070115000220 |
| Provider Name | Robert P Martin |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1497732499 PECOS PAC ID: 1456352939 Enrollment ID: I20070125000531 |
| 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 Mendell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629285556 PECOS PAC ID: 1759481625 Enrollment ID: I20070706000032 |
| Provider Name | Michael J Racenstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154314912 PECOS PAC ID: 1850486861 Enrollment ID: I20071005000545 |
| Provider Name | Gaurav Kapoor |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1245225192 PECOS PAC ID: 6800869322 Enrollment ID: I20071005000561 |
| 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 | 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 | Kristin Balthazor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1649422619 PECOS PAC ID: 0345398921 Enrollment ID: I20090508000520 |
| Provider Name | John J Ciemins |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316965569 PECOS PAC ID: 9931006764 Enrollment ID: I20090515000250 |
| 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 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 | Lori J Williams |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881762540 PECOS PAC ID: 7618020769 Enrollment ID: I20090806000547 |
| Provider Name | Naresh C Chandan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811094550 PECOS PAC ID: 7810041290 Enrollment ID: I20090827000637 |
| Provider Name | Janaki Natarajan |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1306068200 PECOS PAC ID: 6305939810 Enrollment ID: I20091106000302 |
| 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 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 - Interventional 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 | James R Brorson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1831240811 PECOS PAC ID: 3072702448 Enrollment ID: I20110117000168 |
| 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 | Karie L Prokop |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1447558127 PECOS PAC ID: 9436336989 Enrollment ID: I20110609000156 |
| 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 | Eric D Donnelly |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1124284922 PECOS PAC ID: 1850549510 Enrollment ID: I20120921000252 |
| Provider Name | Sinan Simsir |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1528142445 PECOS PAC ID: 5698728889 Enrollment ID: I20130218000425 |
| 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 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 | Davina M Betts |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1558494724 PECOS PAC ID: 1254496748 Enrollment ID: I20130612000238 |
| 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 | Karim H Bouferrache |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1780969634 PECOS PAC ID: 6901045913 Enrollment ID: I20130625000134 |
| 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 | 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 | Kathryn 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 | Donald Graves |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1841579471 PECOS PAC ID: 4587880661 Enrollment ID: I20140725001152 |
| Provider Name | Anupama Shivaraju |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1417133190 PECOS PAC ID: 3870719677 Enrollment ID: I20140731001791 |
| Provider Name | Leanne M Bishop |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1578811147 PECOS PAC ID: 7810114428 Enrollment ID: I20140805001982 |
| Provider Name | Roselle Almeida |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1720243645 PECOS PAC ID: 7113145186 Enrollment ID: I20140904001750 |
| Provider Name | Didi E Omiyi |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1467618561 PECOS PAC ID: 4082833538 Enrollment ID: I20140915001535 |
| Provider Name | Jonathan C Cotton |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1023273901 PECOS PAC ID: 8628298601 Enrollment ID: I20140926000782 |
| Provider Name | Jessica M Nicholson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033435557 PECOS PAC ID: 7517187750 Enrollment ID: I20141009002319 |
| Provider Name | Thomas a Shin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386852010 PECOS PAC ID: 3870676372 Enrollment ID: I20141106000137 |
| Provider Name | Jessica a Morales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770982464 PECOS PAC ID: 9436471489 Enrollment ID: I20141203000437 |
| Provider Name | Saud Ahmed |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1255592655 PECOS PAC ID: 0840416756 Enrollment ID: I20150106002488 |
| 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 Sehgal 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 | Deepa MD Sheth |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174753263 PECOS PAC ID: 8921313131 Enrollment ID: I20150818003846 |
| Provider Name | Brant M Balthazor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1548640774 PECOS PAC ID: 5496063208 Enrollment ID: I20150928002944 |
| 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 | Brett Taylor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881063428 PECOS PAC ID: 0648580662 Enrollment ID: I20151103002867 |
| 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 | 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 | Tanya M Bowsher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952799843 PECOS PAC ID: 2466757331 Enrollment ID: I20160302000237 |
| Provider Name | Tiffany N. Perdue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538564448 PECOS PAC ID: 7618273475 Enrollment ID: I20160304001607 |
| 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 | Gretchen Williams |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659663581 PECOS PAC ID: 0143517151 Enrollment ID: I20160919002554 |
| Provider Name | Mihir B Shah |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1972730893 PECOS PAC ID: 6709105018 Enrollment ID: I20160923000456 |
| 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 | Kristen Yunker Mars |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568993962 PECOS PAC ID: 3577840701 Enrollment ID: I20170426000012 |
| Provider Name | Christin M Demierre |
|---|---|
| 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 | Mohammed Mohsin 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 | Andrew J Donofrio |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1124546221 PECOS PAC ID: 4587930383 Enrollment ID: I20171023002465 |
| 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 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 | 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 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 | 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 | 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 | Christos Lazaridis |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1457497802 PECOS PAC ID: 8123191566 Enrollment ID: I20180924001143 |
| 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 | Ahmad Daif |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326459553 PECOS PAC ID: 5890082317 Enrollment ID: I20181128000862 |
| Provider Name | Jenna Nicole Sarna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104393180 PECOS PAC ID: 9133463383 Enrollment ID: I20181129001166 |
| Provider Name | Carly E. Kaminke |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1548741945 PECOS PAC ID: 4789928771 Enrollment ID: I20181203000365 |
| Provider Name | Sarah Nicole Leveque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649755109 PECOS PAC ID: 8426393679 Enrollment ID: I20181217002806 |
| Provider Name | Michael J Grecula |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1952480550 PECOS PAC ID: 2365505401 Enrollment ID: I20190128000793 |
| 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 | Cheryl B Hansen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003370982 PECOS PAC ID: 2769722164 Enrollment ID: I20190321001913 |
| Provider Name | Alok Mukesh 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 | Vivek Patel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801139670 PECOS PAC ID: 3678852100 Enrollment ID: I20190517001900 |
| Provider Name | Vidita V Khatri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588072292 PECOS PAC ID: 8123314572 Enrollment ID: I20190531000385 |
| Provider Name | Ahmad Chaudhry |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1144304635 PECOS PAC ID: 0547386849 Enrollment ID: I20190703002396 |
| Provider Name | Frank L Narcisi |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1285083352 PECOS PAC ID: 1153656178 Enrollment ID: I20190713000000 |
| 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 | Divya Kumari |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669881702 PECOS PAC ID: 9739413097 Enrollment ID: I20190726002592 |
| Provider Name | Ali Mansour |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1760822597 PECOS PAC ID: 4183927908 Enrollment ID: I20190729000442 |
| 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 Funk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780141234 PECOS PAC ID: 3173851771 Enrollment ID: I20190820004017 |
| Provider Name | Dennis Prohaska |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1689651010 PECOS PAC ID: 3375526494 Enrollment ID: I20190822000191 |
| 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 Clemens |
|---|---|
| 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 Chen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558757757 PECOS PAC ID: 9335424449 Enrollment ID: I20191210002786 |
| Provider Name | Quantel V. 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 | Joanna L Lambert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659775534 PECOS PAC ID: 6002126117 Enrollment ID: I20200313001329 |
| Provider Name | Courtney Sabry |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1639719834 PECOS PAC ID: 8729417712 Enrollment ID: I20200326000372 |
| 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 | Patrick Moore |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1639525371 PECOS PAC ID: 7810280559 Enrollment ID: I20200625002411 |
| Provider Name | Krista Rose Barton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144854373 PECOS PAC ID: 6204259336 Enrollment ID: I20200708002661 |
| Provider Name | Tori A. Lafleur |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447639422 PECOS PAC ID: 7719212927 Enrollment ID: I20200709002871 |
| 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 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 | Craig Akoh |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1467890145 PECOS PAC ID: 6406099019 Enrollment ID: I20200817000156 |
| Provider Name | Lena Khaled Alia |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578926143 PECOS PAC ID: 6002232311 Enrollment ID: I20200818001045 |
| Provider Name | Talal Akhter |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1356760995 PECOS PAC ID: 0840412151 Enrollment ID: I20200820000129 |
| 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 | Mary Brandenburg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003394024 PECOS PAC ID: 0648521096 Enrollment ID: I20210125001221 |
| Provider Name | Jason J Shin |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1699229435 PECOS PAC ID: 1254746456 Enrollment ID: I20210222001696 |
| Provider Name | Tara L 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 | Shamit Desai |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1285074104 PECOS PAC ID: 2961747555 Enrollment ID: I20210715004030 |
| Provider Name | Lisa Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154810778 PECOS PAC ID: 3375891930 Enrollment ID: I20210719003436 |
| Provider Name | Vinay Bajaj |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1619325446 PECOS PAC ID: 5597052738 Enrollment ID: I20210721000658 |
| 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 Y 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 | Mary Elizabeth Anderson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1487662060 PECOS PAC ID: 1052210762 Enrollment ID: I20220127001810 |
| Provider Name | Harneet Singh Pahwa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871807883 PECOS PAC ID: 8426340472 Enrollment ID: I20220127001893 |
| 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 | Megan Price |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467109538 PECOS PAC ID: 4284020280 Enrollment ID: I20220330002391 |
| Provider Name | Westley D Zimmer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023465150 PECOS PAC ID: 6305131285 Enrollment ID: I20220516000528 |
| Provider Name | Yehuda Kerbel |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1639608797 PECOS PAC ID: 7911384540 Enrollment ID: I20220607003346 |
| Provider Name | Jehad Zakaria |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1225455181 PECOS PAC ID: 3577942283 Enrollment ID: I20220625000312 |
| Provider Name | Hashir Saeed |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902251929 PECOS PAC ID: 4688966773 Enrollment ID: I20220627002614 |
| Provider Name | Reid Thomas Alley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568956043 PECOS PAC ID: 2860873510 Enrollment ID: I20220713001065 |
| Provider Name | Aneesa Gaffar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699153890 PECOS PAC ID: 1052606423 Enrollment ID: I20220714001823 |
| Provider Name | Niketa Kataria |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780115212 PECOS PAC ID: 8325393838 Enrollment ID: I20220721000358 |
| 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 L Frogge |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1982017943 PECOS PAC ID: 0244455590 Enrollment ID: I20220811000672 |
| Provider Name | Mairaj M Uddin |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1689037855 PECOS PAC ID: 8426453556 Enrollment ID: I20220822000701 |
| Provider Name | Rylee Olewinski |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1568880029 PECOS PAC ID: 1355762782 Enrollment ID: I20220913002374 |
| Provider Name | Jaelyn Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659909372 PECOS PAC ID: 6800209115 Enrollment ID: I20220920003694 |
| Provider Name | Jessica L Alston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922458405 PECOS PAC ID: 8426340704 Enrollment ID: I20220921003784 |
| Provider Name | Melanie J 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 | Tejas Sanjay Ranade |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1043702459 PECOS PAC ID: 9830563873 Enrollment ID: I20230316001963 |
| Provider Name | Kendra Ann Pauley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720792617 PECOS PAC ID: 6204201742 Enrollment ID: I20230414000048 |
| Provider Name | Princy George |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467800466 PECOS PAC ID: 7517293293 Enrollment ID: I20230420001390 |
| 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 M 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 | Katelyn Rugino |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1669741997 PECOS PAC ID: 4587831383 Enrollment ID: I20230705002041 |
| Provider Name | Vivek 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 J 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 | Ozair Rahman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417483090 PECOS PAC ID: 0042694564 Enrollment ID: I20230821003604 |
| Provider Name | Liji Surrao |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962118802 PECOS PAC ID: 5092178079 Enrollment ID: I20230823002893 |
| Provider Name | Ashraf a Uddin |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1699262782 PECOS PAC ID: 3375946742 Enrollment ID: I20230824002326 |
| Provider Name | Pouyan Arman |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1679952071 PECOS PAC ID: 7618286063 Enrollment ID: I20230830001584 |
| 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 | Tracey Fan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174055784 PECOS PAC ID: 2860761327 Enrollment ID: I20230911002186 |
| Provider Name | Amy Elizabeth Espinal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1114380318 PECOS PAC ID: 1658615588 Enrollment ID: I20230922003043 |
| Provider Name | James E Siegler |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1104265529 PECOS PAC ID: 8527332394 Enrollment ID: I20230925000107 |
| Provider Name | Jibran Rana |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1043638729 PECOS PAC ID: 8729207865 Enrollment ID: I20230925001165 |
| 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 | William H Roth |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1124460803 PECOS PAC ID: 8729357504 Enrollment ID: I20231103001784 |
| Provider Name | Rami-james K Assadi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265819478 PECOS PAC ID: 8325343247 Enrollment ID: I20231108002019 |
| Provider Name | Jeremiah Bell |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1639533870 PECOS PAC ID: 0244524338 Enrollment ID: I20231201001258 |
| Provider Name | Sam Kumar Saha |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629394390 PECOS PAC ID: 3870733181 Enrollment ID: I20231206001098 |
| 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 |
| Provider Name | Kendreea Marie Hodges |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285495937 PECOS PAC ID: 2668819814 Enrollment ID: I20240322002855 |
| Provider Name | Hilda Kina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316727308 PECOS PAC ID: 4183061112 Enrollment ID: I20240326001157 |
| Provider Name | Roger Hartline |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821705229 PECOS PAC ID: 5496196131 Enrollment ID: I20240513003598 |
| Provider Name | Amirreza Fallahi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235766916 PECOS PAC ID: 4082037429 Enrollment ID: I20240611000485 |
| Provider Name | Clementina Asamoah |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043830698 PECOS PAC ID: 8224459482 Enrollment ID: I20240617000459 |
| Provider Name | Latangela Smith |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790162493 PECOS PAC ID: 4587979232 Enrollment ID: I20240627001438 |
| Provider Name | Elizabeth E Carroll |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1982137618 PECOS PAC ID: 0042557175 Enrollment ID: I20240722002116 |
| Provider Name | Mary Elizabeth Copeland Kozak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689255028 PECOS PAC ID: 9234676438 Enrollment ID: I20240806002107 |
| Provider Name | Tracey Samantha Peachey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124872924 PECOS PAC ID: 1254879851 Enrollment ID: I20240814001704 |
| Provider Name | Payal Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497339162 PECOS PAC ID: 4082011861 Enrollment ID: I20240820000575 |
| Provider Name | Rachel P Mehendale |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1235558842 PECOS PAC ID: 8426305756 Enrollment ID: I20240822001497 |
| Provider Name | Akhil Shori |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1629547807 PECOS PAC ID: 2062741382 Enrollment ID: I20240830002008 |
| Provider Name | Charonn Woods |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1396109062 PECOS PAC ID: 9638461379 Enrollment ID: I20240906003508 |
| Provider Name | Kevin C Varghese |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477181071 PECOS PAC ID: 7416371588 Enrollment ID: I20240906004182 |
| Provider Name | Emma Faith Cheatham |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1588346779 PECOS PAC ID: 9032650247 Enrollment ID: I20240916000815 |
| Provider Name | Matthew Evan Guimond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295416543 PECOS PAC ID: 5092256909 Enrollment ID: I20240919000121 |
| Provider Name | Mustafa Khan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1861489601 PECOS PAC ID: 0345317277 Enrollment ID: I20240923002797 |
| Provider Name | Aravind B Reddy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548756588 PECOS PAC ID: 9436527447 Enrollment ID: I20240924004198 |
| Provider Name | Deborah Huang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225420961 PECOS PAC ID: 4082958426 Enrollment ID: I20240930003353 |
| Provider Name | Laura Redenius |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558119784 PECOS PAC ID: 3779015342 Enrollment ID: I20241021002631 |
| Provider Name | Ramzy Fares |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740862663 PECOS PAC ID: 4284169772 Enrollment ID: I20241120002836 |
| Provider Name | Kirstin Olha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922823244 PECOS PAC ID: 7012390628 Enrollment ID: I20250102003120 |
| Provider Name | Manan Dhingra |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1679099626 PECOS PAC ID: 3274957782 Enrollment ID: I20250213001238 |
| Provider Name | Ian Wilson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871793570 PECOS PAC ID: 6305935388 Enrollment ID: I20250304000644 |
| Provider Name | Neil Bhathela |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1851820567 PECOS PAC ID: 2163793829 Enrollment ID: I20250319003679 |
| Provider Name | Rosaura Garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356147656 PECOS PAC ID: 6800310947 Enrollment ID: I20250409003911 |
| Provider Name | Donna Ellen Newsome |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225132277 PECOS PAC ID: 9234233529 Enrollment ID: I20250501000118 |
| Provider Name | Karen Orjuela Traslavina |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1699060640 PECOS PAC ID: 6507168812 Enrollment ID: I20250520002639 |
| Provider Name | Robin Motz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144012659 PECOS PAC ID: 9032628037 Enrollment ID: I20250602001774 |
| Provider Name | Parmis Fatih |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407434129 PECOS PAC ID: 7214330935 Enrollment ID: I20250611002761 |
| Provider Name | Mekasha Mikael Getachew |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1619988847 PECOS PAC ID: 8325015381 Enrollment ID: I20250717002364 |
| Provider Name | Monis Syed |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1598393043 PECOS PAC ID: 8325443161 Enrollment ID: I20250721002611 |
| Provider Name | Aileen Sim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689489080 PECOS PAC ID: 7719494426 Enrollment ID: I20250728003452 |
| Provider Name | Alec Hayes Fisher |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1386207702 PECOS PAC ID: 5193232544 Enrollment ID: I20250730000148 |
| Provider Name | Andrew T Mariano |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1255991303 PECOS PAC ID: 1557768595 Enrollment ID: I20250806002320 |
| Provider Name | Santosh Bhat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225667223 PECOS PAC ID: 6406218601 Enrollment ID: I20250807001125 |
| Provider Name | Hami Ramani |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1871819284 PECOS PAC ID: 2466760939 Enrollment ID: I20250807003881 |
| Provider Name | Bakht Bedaar Siddiqui |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386273365 PECOS PAC ID: 2365801149 Enrollment ID: I20250828004059 |
| Provider Name | Eesha Singh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1114546231 PECOS PAC ID: 7214470236 Enrollment ID: I20250828004306 |
| Provider Name | Daniela Echeverri Idrobo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730071788 PECOS PAC ID: 0446753107 Enrollment ID: I20250910002193 |
| Provider Name | Ryan Greene |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1518171107 PECOS PAC ID: 2062676778 Enrollment ID: I20250915000715 |
| Provider Name | Ali R Eltatawy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1285263186 PECOS PAC ID: 5496154825 Enrollment ID: I20250926003023 |
| Provider Name | Cristian Salazar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851275697 PECOS PAC ID: 6002312071 Enrollment ID: I20250930002101 |
| Provider Name | Kenaz Bakdash |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881122273 PECOS PAC ID: 4587932579 Enrollment ID: I20251014002034 |
| Provider Name | Khadija a Ali |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1902425549 PECOS PAC ID: 8729583422 Enrollment ID: I20251029003532 |
| Provider Name | Lindsey Goodwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912879834 PECOS PAC ID: 6002307691 Enrollment ID: I20251111003595 |
| Provider Name | Julie Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497112684 PECOS PAC ID: 5193218139 Enrollment ID: I20251208000802 |
| Provider Name | Harpreet Kaur Virk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407586266 PECOS PAC ID: 1557855715 Enrollment ID: I20251215002146 |
| Provider Name | James Choi |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1063907947 PECOS PAC ID: 4587065644 Enrollment ID: I20251219000296 |
| Provider Name | Steven Dale Arbogast |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962615377 PECOS PAC ID: 3375697774 Enrollment ID: I20251222003390 |
| Provider Name | Lachanda Dunlap-wright |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1447609870 PECOS PAC ID: 0042631038 Enrollment ID: I20251223004054 |
| Provider Name | Stephen Avila |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1093394058 PECOS PAC ID: 8820587652 Enrollment ID: I20251224001720 |
| Provider Name | Manal Alharsha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346103587 PECOS PAC ID: 5698251122 Enrollment ID: I20260114002185 |
| Provider Name | Elizabeth A. Venice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720942808 PECOS PAC ID: 0446737670 Enrollment ID: I20260120001485 |
| Provider Name | Siddharth Dalal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811488455 PECOS PAC ID: 4789928730 Enrollment ID: I20260127002075 |
| Provider Name | Snigdha Kalidindi |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1417535477 PECOS PAC ID: 8022427780 Enrollment ID: I20260128003315 |
| Provider Name | Evelyn Mata |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033905070 PECOS PAC ID: 8123545829 Enrollment ID: I20260209002489 |
| Provider Name | Ryan Charles Scott Whitesell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154287571 PECOS PAC ID: 0749760742 Enrollment ID: I20260218001367 |
| Provider Name | Fahd Abdullah Syed |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1457619702 PECOS PAC ID: 5991021313 Enrollment ID: I20260220000849 |
| Provider Name | Uzoma Nwakibu |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1184253916 PECOS PAC ID: 4880175017 Enrollment ID: I20260225002321 |
| Provider Name | Payam Moein |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1437535481 PECOS PAC ID: 6204167372 Enrollment ID: I20260227000593 |
| Provider Name | Dawn Josette Levy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710213087 PECOS PAC ID: 8325522006 Enrollment ID: I20260320000239 |
| Provider Name | Mary Patricia Stell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336094374 PECOS PAC ID: 9032684261 Enrollment ID: I20260406002643 |
| Provider Name | Jennifer Lyn James |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265138838 PECOS PAC ID: 6406321330 Enrollment ID: I20260408003310 |
| Provider Name | Jennifer Jones |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598727281 PECOS PAC ID: 2567493034 Enrollment ID: I20260515003525 |
| Provider Name | Haley Rose Radev |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1801752209 PECOS PAC ID: 2567932163 Enrollment ID: I20260526000057 |
| Provider Name | Zain S Talukdar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1083302624 PECOS PAC ID: 6709245624 Enrollment ID: I20260529003225 |
| Provider Name | Vince Kyle Morgan |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1346876224 PECOS PAC ID: 3779908868 Enrollment ID: I20260616002948 |
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: Not Enrolled in Medicare 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 |