| San Xavier Health Center | |
|
7900 S J Stock Rd Tucson AZ 85746-7012 | |
| (520) 295-2546 | |
| (520) 295-2676 |
| Full Name | San Xavier Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 7900 S J Stock Rd, Tucson, Arizona |
| Authorized Official Name and Position | Diane Shanley (DEPUTY CEO) |
| Authorized Official Contact | 5203837285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Xavier Health Center 7900 S J Stock Rd Tucson AZ 85746-7012 Ph: (520) 295-2546 | San Xavier Health Center 7900 S J Stock Rd Tucson AZ 85746-7012 Ph: (520) 295-2546 |
| NPI Number | 1437157302 |
|---|---|
| Provider Enumeration Date | 07/13/2005 |
| Last Update Date | 03/15/2017 |
| Medicare PECOS PAC ID | 6608819339 |
|---|---|
| Medicare Enrollment ID | O20050603000721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437157302 | NPI | - | NPPES |
| 0325678 | Other | AZ | NACADP# |
| AZ0209600 | Other | AZ | BC/BSAZ DENTAL PROV NO |
| 03D0864297 | Other | AZ | CLIA # |
| 147133-03 | Medicaid | AZ | |
| AZ0209620 | Other | AZ | BC/BSAZ PROV NO |
| 1437157302 | Other | AZ | FACILITY NPI # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0904X | Clinic/center - Public Health, Federal | (* (Not Available)) | Primary |
| Provider Name | Andrew L Tievsky |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861458788 PECOS PAC ID: 6507779048 Enrollment ID: I20031110000750 |
| Provider Name | Marisa J Werner |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073603205 PECOS PAC ID: 0648175869 Enrollment ID: I20031201000835 |
| Provider Name | Navid A Ardakani |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669512760 PECOS PAC ID: 5193621886 Enrollment ID: I20031211001127 |
| Provider Name | Jonathan Michael Foral |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477576064 PECOS PAC ID: 1951292903 Enrollment ID: I20040322000363 |
| Provider Name | Eric A Brody |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730290172 PECOS PAC ID: 0345132171 Enrollment ID: I20040326000884 |
| Provider Name | Peter Alexander Ziegler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225128135 PECOS PAC ID: 5395730634 Enrollment ID: I20040416001005 |
| Provider Name | Kevin Mcdonnell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578548533 PECOS PAC ID: 1052309101 Enrollment ID: I20040505001457 |
| Provider Name | Martin L Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730165671 PECOS PAC ID: 2365492048 Enrollment ID: I20050131000455 |
| Provider Name | Tamiko N Olson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487734687 PECOS PAC ID: 8224088851 Enrollment ID: I20050131000948 |
| Provider Name | James E Olson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982784971 PECOS PAC ID: 7911957550 Enrollment ID: I20050131000994 |
| Provider Name | Martha M Develasco |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1457431561 PECOS PAC ID: 0648221135 Enrollment ID: I20050202000144 |
| Provider Name | Paul D Weintraub |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083793772 PECOS PAC ID: 4183676174 Enrollment ID: I20050217000876 |
| Provider Name | Candice P Speakman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134209323 PECOS PAC ID: 4789636788 Enrollment ID: I20050217000910 |
| Provider Name | Susan L. Hausser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306926324 PECOS PAC ID: 2860446051 Enrollment ID: I20050310000395 |
| Provider Name | Brenda G Neufeld |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609956713 PECOS PAC ID: 6901852003 Enrollment ID: I20050322000788 |
| Provider Name | Leslie P King |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1649201211 PECOS PAC ID: 9032166004 Enrollment ID: I20050401000166 |
| Provider Name | Yulia Bronstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578677647 PECOS PAC ID: 6901839463 Enrollment ID: I20050914001339 |
| Provider Name | Benjamin Strong |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205811569 PECOS PAC ID: 8426048232 Enrollment ID: I20051004000655 |
| Provider Name | Donald Nicell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689679631 PECOS PAC ID: 2769458819 Enrollment ID: I20051004000740 |
| Provider Name | Susan Pinero |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164437026 PECOS PAC ID: 0042239428 Enrollment ID: I20051115000498 |
| Provider Name | Stephanie Runyan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740351543 PECOS PAC ID: 2668413576 Enrollment ID: I20060424000501 |
| Provider Name | Julia A Hardeman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659359628 PECOS PAC ID: 8325142680 Enrollment ID: I20070327000497 |
| Provider Name | Scott A Allison |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780624254 PECOS PAC ID: 7618077066 Enrollment ID: I20070713000469 |
| Provider Name | Parina G Cho |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790770261 PECOS PAC ID: 5193623486 Enrollment ID: I20070801000820 |
| Provider Name | Tyler A Pickrell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558442319 PECOS PAC ID: 5890886733 Enrollment ID: I20070807000835 |
| Provider Name | Andrew J Terranella |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467668145 PECOS PAC ID: 5193812451 Enrollment ID: I20071102000222 |
| Provider Name | Mark W Kleve |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578600045 PECOS PAC ID: 9638250079 Enrollment ID: I20080111000272 |
| Provider Name | Nima N Desai |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1912083908 PECOS PAC ID: 1456437284 Enrollment ID: I20080319000514 |
| Provider Name | Bowen C Tzeng |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952591760 PECOS PAC ID: 5294807079 Enrollment ID: I20080710000757 |
| Provider Name | Waheed Jalalzai |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669444246 PECOS PAC ID: 6305816513 Enrollment ID: I20081204000076 |
| Provider Name | Ramesh Karra |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891759452 PECOS PAC ID: 5698725851 Enrollment ID: I20090218000333 |
| Provider Name | Faraz Khan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790776771 PECOS PAC ID: 3870658032 Enrollment ID: I20090302000408 |
| Provider Name | Kelly R. Yablonski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467663799 PECOS PAC ID: 8729144159 Enrollment ID: I20090309000665 |
| Provider Name | Regina E Ross |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063690014 PECOS PAC ID: 3870640949 Enrollment ID: I20090406000568 |
| Provider Name | James A Hagan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649458423 PECOS PAC ID: 6709933633 Enrollment ID: I20090413000211 |
| Provider Name | Tamara Wheeler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114085693 PECOS PAC ID: 8628116571 Enrollment ID: I20091112000587 |
| Provider Name | Laura H Veal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225364599 PECOS PAC ID: 0446393250 Enrollment ID: I20100202000541 |
| Provider Name | Pearl Kloac |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427143593 PECOS PAC ID: 0648372722 Enrollment ID: I20100317000742 |
| Provider Name | Jennifer H Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366601932 PECOS PAC ID: 5991830499 Enrollment ID: I20100323000713 |
| Provider Name | Kurtis Tedesco |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396969945 PECOS PAC ID: 5496809709 Enrollment ID: I20100427000803 |
| Provider Name | Mark W Reckson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588710487 PECOS PAC ID: 6507895505 Enrollment ID: I20100506000161 |
| Provider Name | Brian Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194977116 PECOS PAC ID: 4385760297 Enrollment ID: I20100929000153 |
| Provider Name | Autumn E Stevenson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801092747 PECOS PAC ID: 7416130216 Enrollment ID: I20110331000179 |
| Provider Name | Mark A Mcgehee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548243165 PECOS PAC ID: 4486647310 Enrollment ID: I20110609000731 |
| Provider Name | Vibhu Kapoor |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952499048 PECOS PAC ID: 2668408089 Enrollment ID: I20120123000144 |
| Provider Name | Lane C Luna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609080662 PECOS PAC ID: 2062676158 Enrollment ID: I20120621000556 |
| Provider Name | Lars E Krusholm |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1356312532 PECOS PAC ID: 0345406302 Enrollment ID: I20120719000598 |
| Provider Name | Miyoshi Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457684110 PECOS PAC ID: 1850438250 Enrollment ID: I20120917000553 |
| Provider Name | Jennifer C Mayne |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346431533 PECOS PAC ID: 5496909368 Enrollment ID: I20130130000033 |
| Provider Name | Ginger A Vaughn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558592360 PECOS PAC ID: 3173657848 Enrollment ID: I20130218000275 |
| Provider Name | Stacey Gyenizse |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1568748259 PECOS PAC ID: 5395981617 Enrollment ID: I20130411000148 |
| Provider Name | Amy J Kroeger |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609023571 PECOS PAC ID: 3274772850 Enrollment ID: I20130611000427 |
| Provider Name | David M Moon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548213812 PECOS PAC ID: 2769476555 Enrollment ID: I20130715000777 |
| Provider Name | Justin Boe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205925864 PECOS PAC ID: 5496754988 Enrollment ID: I20130723000071 |
| Provider Name | Christine Lamoureux |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275578593 PECOS PAC ID: 8729978499 Enrollment ID: I20130723000743 |
| Provider Name | Karen Caldemeyer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1679511356 PECOS PAC ID: 9931003506 Enrollment ID: I20130726000311 |
| Provider Name | Karen G Phillips |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801992813 PECOS PAC ID: 8729024161 Enrollment ID: I20130726000670 |
| Provider Name | Thomas D Henry |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104848902 PECOS PAC ID: 6608872999 Enrollment ID: I20130727000227 |
| Provider Name | Bruce Reiner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447235783 PECOS PAC ID: 7911008602 Enrollment ID: I20130727000264 |
| Provider Name | Joshua R Sokol |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1831229699 PECOS PAC ID: 9234032855 Enrollment ID: I20130730000008 |
| Provider Name | Koreen Potts |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477540516 PECOS PAC ID: 3779577333 Enrollment ID: I20130730000107 |
| Provider Name | Christopher E Rickman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497759898 PECOS PAC ID: 4082703277 Enrollment ID: I20130805000914 |
| Provider Name | Sumeet Verma |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770760134 PECOS PAC ID: 8426129941 Enrollment ID: I20130808000134 |
| Provider Name | Stephanie Heinlen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588601371 PECOS PAC ID: 6800805250 Enrollment ID: I20130927000026 |
| Provider Name | Gregg Sydow |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619157609 PECOS PAC ID: 6002057296 Enrollment ID: I20131015001855 |
| Provider Name | Maria Colombo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013974948 PECOS PAC ID: 1951311059 Enrollment ID: I20131015001942 |
| Provider Name | Melissa Suzanne Mcguinness |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831433499 PECOS PAC ID: 0446485783 Enrollment ID: I20131023000264 |
| Provider Name | Richard Mitchell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255368353 PECOS PAC ID: 9436045713 Enrollment ID: I20140210000640 |
| Provider Name | Terence Hamel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649240334 PECOS PAC ID: 7113950999 Enrollment ID: I20140213000715 |
| Provider Name | Christopher P Marshall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043278724 PECOS PAC ID: 0446285217 Enrollment ID: I20140228001336 |
| Provider Name | Jeffrey G Zorn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750366498 PECOS PAC ID: 1052406832 Enrollment ID: I20140319000711 |
| Provider Name | Charles Henry |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134211931 PECOS PAC ID: 6901820620 Enrollment ID: I20140319001395 |
| Provider Name | Michael C Diantonio |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528118163 PECOS PAC ID: 4284714429 Enrollment ID: I20140328001437 |
| Provider Name | Joshua Albrektson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104155258 PECOS PAC ID: 2466699855 Enrollment ID: I20140603002393 |
| Provider Name | Asif Abdullah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861620601 PECOS PAC ID: 9335305622 Enrollment ID: I20140627000689 |
| Provider Name | Christopher J Morgan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316985914 PECOS PAC ID: 6901790765 Enrollment ID: I20140818001969 |
| Provider Name | John Edward Stewart |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053367250 PECOS PAC ID: 7517947815 Enrollment ID: I20141218002356 |
| Provider Name | Reed K Burk |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1023013760 PECOS PAC ID: 6901854579 Enrollment ID: I20141223001452 |
| Provider Name | Raman Kansal |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346209889 PECOS PAC ID: 6901832211 Enrollment ID: I20150109000633 |
| Provider Name | Scott Chang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962454645 PECOS PAC ID: 9537146212 Enrollment ID: I20150122000280 |
| Provider Name | Kamron Izadi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871757005 PECOS PAC ID: 8426200783 Enrollment ID: I20150130001863 |
| Provider Name | Joshua Morais |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669674651 PECOS PAC ID: 5991855017 Enrollment ID: I20150213001364 |
| Provider Name | Raymond J Facco |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376594507 PECOS PAC ID: 7416927694 Enrollment ID: I20150216001369 |
| Provider Name | Brendan Miner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588616338 PECOS PAC ID: 0749253052 Enrollment ID: I20150417001414 |
| Provider Name | Nausheen Naveed |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508182742 PECOS PAC ID: 8022234582 Enrollment ID: I20150417001634 |
| Provider Name | Aarthi R Jude |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1427473339 PECOS PAC ID: 6608195383 Enrollment ID: I20150430001196 |
| Provider Name | James P Corcoran |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063899540 PECOS PAC ID: 2163742388 Enrollment ID: I20150528002522 |
| Provider Name | Jae Dell M Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215361787 PECOS PAC ID: 8123349610 Enrollment ID: I20150609002469 |
| Provider Name | Sarah Almand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366748972 PECOS PAC ID: 9032422514 Enrollment ID: I20150714000766 |
| Provider Name | Johnice J Barajas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063808467 PECOS PAC ID: 5395058903 Enrollment ID: I20150724010850 |
| Provider Name | Marnie G Lamm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689992265 PECOS PAC ID: 4981720364 Enrollment ID: I20150807013117 |
| Provider Name | Daniel R Marino |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396703757 PECOS PAC ID: 6406871433 Enrollment ID: I20150912000112 |
| Provider Name | Bridget Katherine Peterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346516531 PECOS PAC ID: 4385877828 Enrollment ID: I20150923000923 |
| Provider Name | Elisabeth Jane Gibbons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790042182 PECOS PAC ID: 7012158652 Enrollment ID: I20151024000010 |
| Provider Name | Steven C Zwerdlinger |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790737328 PECOS PAC ID: 5698661742 Enrollment ID: I20151109001475 |
| Provider Name | Laura M Wike |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174589543 PECOS PAC ID: 1658362652 Enrollment ID: I20151109001973 |
| Provider Name | Saadet Atay-rosenthal |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336387059 PECOS PAC ID: 5799686093 Enrollment ID: I20151118002360 |
| Provider Name | Sara Banerjee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194928416 PECOS PAC ID: 2860525052 Enrollment ID: I20151119000855 |
| Provider Name | Stacy Greenspan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336124825 PECOS PAC ID: 4587679444 Enrollment ID: I20151124000703 |
| Provider Name | Peter A Reding |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043519358 PECOS PAC ID: 0648573121 Enrollment ID: I20160115000865 |
| Provider Name | Adam Rulnick |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811041031 PECOS PAC ID: 6800987017 Enrollment ID: I20160209002812 |
| Provider Name | Alison M Robinette |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649444761 PECOS PAC ID: 1355529157 Enrollment ID: I20160223001116 |
| Provider Name | Gregory Alan Bosh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1235303215 PECOS PAC ID: 1254557713 Enrollment ID: I20160309000420 |
| Provider Name | Jay Donohoo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194846345 PECOS PAC ID: 5597863613 Enrollment ID: I20160310002422 |
| Provider Name | John R Bennett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558385666 PECOS PAC ID: 7012905177 Enrollment ID: I20160401001121 |
| Provider Name | Heather Webb |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114119484 PECOS PAC ID: 7719162916 Enrollment ID: I20160414000642 |
| Provider Name | Christopher Garcia |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619103306 PECOS PAC ID: 0648496372 Enrollment ID: I20160415000728 |
| Provider Name | Diane H Conley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528032604 PECOS PAC ID: 1355331273 Enrollment ID: I20160418000097 |
| Provider Name | Michael J Braaton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578547931 PECOS PAC ID: 0648205492 Enrollment ID: I20160418001626 |
| Provider Name | Peter Erigoyen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013997667 PECOS PAC ID: 8527037167 Enrollment ID: I20160419000568 |
| Provider Name | Kathleen A Wooten |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1386743532 PECOS PAC ID: 8527366756 Enrollment ID: I20160420002546 |
| Provider Name | Garry W Pohoretsky |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1740326115 PECOS PAC ID: 2860445251 Enrollment ID: I20160426000776 |
| Provider Name | Denise Nicole Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851507610 PECOS PAC ID: 3779626916 Enrollment ID: I20160429000214 |
| Provider Name | Charles Johnson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750592978 PECOS PAC ID: 6406832716 Enrollment ID: I20160429000957 |
| Provider Name | Tal Delman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083863617 PECOS PAC ID: 1658559505 Enrollment ID: I20160520001969 |
| Provider Name | Diane M Dunst |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477795094 PECOS PAC ID: 1951345230 Enrollment ID: I20160523002339 |
| Provider Name | Christian D Alvarez |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1851726905 PECOS PAC ID: 3173756913 Enrollment ID: I20160525002478 |
| Provider Name | Eric S Postal |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790785087 PECOS PAC ID: 2365476694 Enrollment ID: I20160628000304 |
| Provider Name | William Frederick Middleton |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1134273923 PECOS PAC ID: 8426224452 Enrollment ID: I20160701001694 |
| Provider Name | Jay R Duxin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275592610 PECOS PAC ID: 6800869991 Enrollment ID: I20160726003093 |
| Provider Name | Adam Hecht |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619957834 PECOS PAC ID: 4587695085 Enrollment ID: I20160825001755 |
| Provider Name | Michael L Hynes |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659413805 PECOS PAC ID: 9638261365 Enrollment ID: I20160917000246 |
| Provider Name | James D Balodimas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1730147265 PECOS PAC ID: 6507828621 Enrollment ID: I20160921000135 |
| Provider Name | Patricia O Macfarlane |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750397758 PECOS PAC ID: 4981633674 Enrollment ID: I20160929002286 |
| Provider Name | Thomas A Kavic |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639140882 PECOS PAC ID: 8729076138 Enrollment ID: I20161003000782 |
| Provider Name | Chikaodili I Logie |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1821138538 PECOS PAC ID: 9739326836 Enrollment ID: I20161012000466 |
| Provider Name | Rachel A Shorthouse |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1790232288 PECOS PAC ID: 1951680271 Enrollment ID: I20161109001376 |
| Provider Name | Sheri Lenee Albers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780621615 PECOS PAC ID: 4981699139 Enrollment ID: I20170224000913 |
| Provider Name | Carolyn G Dudley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689651606 PECOS PAC ID: 0547251761 Enrollment ID: I20170301002425 |
| Provider Name | Richard Desruisseau |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1710942172 PECOS PAC ID: 3173536802 Enrollment ID: I20170306002307 |
| Provider Name | Arlene Sussman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417928060 PECOS PAC ID: 2961596002 Enrollment ID: I20170307001474 |
| Provider Name | Barbara E Taylor |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770588006 PECOS PAC ID: 5597730507 Enrollment ID: I20170307002183 |
| Provider Name | Mohamad S Nass |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447630140 PECOS PAC ID: 8729390828 Enrollment ID: I20170309001776 |
| Provider Name | Alan R Richardson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1932451564 PECOS PAC ID: 6709161714 Enrollment ID: I20170314000073 |
| Provider Name | Kenneth Harrison Fox |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164439873 PECOS PAC ID: 8224154141 Enrollment ID: I20170314000142 |
| Provider Name | Ross Parker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1760772800 PECOS PAC ID: 9436457041 Enrollment ID: I20170316002413 |
| Provider Name | Jennifer Gutierrez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750519070 PECOS PAC ID: 5294966958 Enrollment ID: I20170320000892 |
| Provider Name | Mark Z Lanoue |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538159561 PECOS PAC ID: 0042287310 Enrollment ID: I20170320001982 |
| Provider Name | Calvin W Herring |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720083967 PECOS PAC ID: 9133013238 Enrollment ID: I20170321002618 |
| Provider Name | Amy H Tsang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679968804 PECOS PAC ID: 7315222932 Enrollment ID: I20170322002235 |
| Provider Name | Bernadette R Curtis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407858970 PECOS PAC ID: 2860420346 Enrollment ID: I20170327002800 |
| Provider Name | Tracy J Robinson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689998924 PECOS PAC ID: 4688820731 Enrollment ID: I20170330002024 |
| Provider Name | Julie Shaffrey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639154982 PECOS PAC ID: 1850327370 Enrollment ID: I20170407001732 |
| Provider Name | Jennifer K Bogan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720058001 PECOS PAC ID: 5496886509 Enrollment ID: I20170523002239 |
| Provider Name | Kelly M Fath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194262444 PECOS PAC ID: 2062781842 Enrollment ID: I20170711001242 |
| Provider Name | Michelle Jeannette |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861469322 PECOS PAC ID: 8123915931 Enrollment ID: I20170801000542 |
| Provider Name | Susan W Bennett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396849626 PECOS PAC ID: 0446281141 Enrollment ID: I20170802000531 |
| Provider Name | John D Mcarthur |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144206806 PECOS PAC ID: 8527005602 Enrollment ID: I20170802001459 |
| Provider Name | Alison Haimes |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669459392 PECOS PAC ID: 9032304480 Enrollment ID: I20170804001401 |
| Provider Name | Jane B Gauriloff-rothenberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154377117 PECOS PAC ID: 1153324207 Enrollment ID: I20170809002906 |
| Provider Name | Bruce Jay Thaler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477572865 PECOS PAC ID: 4789657636 Enrollment ID: I20170810001577 |
| Provider Name | Jaime Salvatore |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295945673 PECOS PAC ID: 6800053216 Enrollment ID: I20170810002812 |
| Provider Name | Arthur Schneider |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1831141191 PECOS PAC ID: 5092611905 Enrollment ID: I20170811000757 |
| Provider Name | Douglas B Bober |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538141031 PECOS PAC ID: 6709776024 Enrollment ID: I20170811002243 |
| Provider Name | David Y Kim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548453764 PECOS PAC ID: 7012155732 Enrollment ID: I20170812000095 |
| Provider Name | Dietrich W.l. Schultze |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1922192459 PECOS PAC ID: 8325939499 Enrollment ID: I20170821000231 |
| Provider Name | Robert P Henry |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619995628 PECOS PAC ID: 4981660800 Enrollment ID: I20170905000704 |
| Provider Name | Jerome Klein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851349500 PECOS PAC ID: 6800878851 Enrollment ID: I20171004003097 |
| Provider Name | Brandon A Pettit |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750540985 PECOS PAC ID: 1052584349 Enrollment ID: I20171019002365 |
| Provider Name | Robert Sciulli |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114926417 PECOS PAC ID: 2860406451 Enrollment ID: I20171028000218 |
| Provider Name | Rodrigo G Villar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891737359 PECOS PAC ID: 4880793132 Enrollment ID: I20171208001207 |
| Provider Name | Priti B Ram |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043276397 PECOS PAC ID: 9638174477 Enrollment ID: I20180112001803 |
| Provider Name | Carole S Hamburg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1730143561 PECOS PAC ID: 1254312317 Enrollment ID: I20180122001739 |
| Provider Name | Catherine C Roberts |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518940428 PECOS PAC ID: 6608935630 Enrollment ID: I20180202000868 |
| Provider Name | Gillian M Griffith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851322143 PECOS PAC ID: 3274777206 Enrollment ID: I20180213000276 |
| Provider Name | Elise M Nissen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700284312 PECOS PAC ID: 5597025569 Enrollment ID: I20180213000509 |
| Provider Name | Jeong Ho Seo |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1174931133 PECOS PAC ID: 3577824531 Enrollment ID: I20180308000243 |
| Provider Name | Alecia M Rideau |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184648669 PECOS PAC ID: 9234136649 Enrollment ID: I20180309001998 |
| Provider Name | Surinder Rai |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275950925 PECOS PAC ID: 3971814955 Enrollment ID: I20180312000669 |
| Provider Name | Dominick G Sudano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275774937 PECOS PAC ID: 9436326469 Enrollment ID: I20180418001098 |
| Provider Name | Byunyong Choi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558882084 PECOS PAC ID: 3072877075 Enrollment ID: I20180427000307 |
| Provider Name | Jennifer L Harrison-hauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922336866 PECOS PAC ID: 1355605304 Enrollment ID: I20180430000526 |
| Provider Name | Jason Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326452061 PECOS PAC ID: 8628339231 Enrollment ID: I20180515002478 |
| Provider Name | Lawrence S Liebman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033377478 PECOS PAC ID: 4183974827 Enrollment ID: I20180907001162 |
| Provider Name | Tiffany Marie Castellano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063893063 PECOS PAC ID: 4183933351 Enrollment ID: I20190116002298 |
| Provider Name | Gavin W Arnett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841463452 PECOS PAC ID: 3072740554 Enrollment ID: I20190125001277 |
| Provider Name | Edwin Jusino |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1013363993 PECOS PAC ID: 9739426651 Enrollment ID: I20190130000677 |
| Provider Name | Guy N Gibson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417198995 PECOS PAC ID: 8325384258 Enrollment ID: I20190304000209 |
| Provider Name | Brian G Cromwell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548231541 PECOS PAC ID: 2163329764 Enrollment ID: I20190304001163 |
| Provider Name | Duane Charles Wilson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780664664 PECOS PAC ID: 0345137907 Enrollment ID: I20190318000838 |
| Provider Name | Ashley C Ottman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902288350 PECOS PAC ID: 2466733290 Enrollment ID: I20190321000065 |
| Provider Name | Barry F Krieble |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740287218 PECOS PAC ID: 4880636901 Enrollment ID: I20190329000380 |
| Provider Name | Shariq I Chudhri |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1710277751 PECOS PAC ID: 0749408821 Enrollment ID: I20190411000307 |
| Provider Name | Zeeshan Perveze |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1851591895 PECOS PAC ID: 0042304768 Enrollment ID: I20190501001097 |
| Provider Name | Carlos Reyes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831212117 PECOS PAC ID: 1153587134 Enrollment ID: I20190516001564 |
| Provider Name | Karana M Pierre |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1831194042 PECOS PAC ID: 5496715781 Enrollment ID: I20190528001641 |
| Provider Name | Jean M Armand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770641102 PECOS PAC ID: 9436177540 Enrollment ID: I20190603000112 |
| Provider Name | Andrea Galaviz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851740211 PECOS PAC ID: 7810280427 Enrollment ID: I20190815000295 |
| Provider Name | Donn Beeson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740495654 PECOS PAC ID: 6901957448 Enrollment ID: I20191008000795 |
| Provider Name | Evelyn T Panzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174540819 PECOS PAC ID: 9335149129 Enrollment ID: I20200309000150 |
| Provider Name | Edwin M Aquino |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1295034742 PECOS PAC ID: 2668785759 Enrollment ID: I20200405000261 |
| Provider Name | Tracy Dunn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295077808 PECOS PAC ID: 3870736697 Enrollment ID: I20200414002117 |
| Provider Name | Patrick R Doyle |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1811169329 PECOS PAC ID: 5092868349 Enrollment ID: I20200511000545 |
| Provider Name | Igor Zaytsev |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467504027 PECOS PAC ID: 1759566235 Enrollment ID: I20200512001072 |
| Provider Name | Karl Nguyen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477564094 PECOS PAC ID: 4688867930 Enrollment ID: I20200515001364 |
| Provider Name | David Ives |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336127687 PECOS PAC ID: 2961710900 Enrollment ID: I20200903000229 |
| Provider Name | Donald J Kash |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952406837 PECOS PAC ID: 9830163047 Enrollment ID: I20201007000143 |
| Provider Name | Ernest W Kinchen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265415764 PECOS PAC ID: 0244124782 Enrollment ID: I20201012002529 |
| Provider Name | Jinha Park |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811036619 PECOS PAC ID: 2365546934 Enrollment ID: I20201013002543 |
| Provider Name | Peggy Rouleau |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578542585 PECOS PAC ID: 7113055740 Enrollment ID: I20201013003271 |
| Provider Name | Jennifer Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568808939 PECOS PAC ID: 0840610614 Enrollment ID: I20201015003018 |
| Provider Name | Michael F Angelo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1124437520 PECOS PAC ID: 0143559286 Enrollment ID: I20201026003114 |
| Provider Name | Nadezhda Bolton |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1689037509 PECOS PAC ID: 5395089858 Enrollment ID: I20201102001360 |
| Provider Name | Mark Holley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801229232 PECOS PAC ID: 3072743186 Enrollment ID: I20201117002943 |
| Provider Name | Eric G Young |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366642290 PECOS PAC ID: 7618309949 Enrollment ID: I20201214002316 |
| Provider Name | Robert V Filippone |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477512002 PECOS PAC ID: 2668469438 Enrollment ID: I20201223001003 |
| Provider Name | Hares Banuwal |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1285293100 PECOS PAC ID: 2668707142 Enrollment ID: I20210106000341 |
| Provider Name | Syed Anwarulislam |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932518123 PECOS PAC ID: 0749604312 Enrollment ID: I20210115000279 |
| Provider Name | Christopher Macdonald |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043567530 PECOS PAC ID: 8022395482 Enrollment ID: I20210216001389 |
| Provider Name | Mamata C Myneni |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043416654 PECOS PAC ID: 1355505355 Enrollment ID: I20210324000373 |
| Provider Name | Neda Yagan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366466112 PECOS PAC ID: 2466530035 Enrollment ID: I20210330000243 |
| Provider Name | Alap R Jani |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1093796161 PECOS PAC ID: 5193974988 Enrollment ID: I20210504000047 |
| Provider Name | Eric J Kraemer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881621621 PECOS PAC ID: 1153429469 Enrollment ID: I20210506001225 |
| Provider Name | Lucia Esmeralda Obregon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548758709 PECOS PAC ID: 2365791142 Enrollment ID: I20210506003062 |
| Provider Name | Matthew Smetko |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639564479 PECOS PAC ID: 7911217971 Enrollment ID: I20210517001311 |
| Provider Name | James E Denier |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780689497 PECOS PAC ID: 2668371378 Enrollment ID: I20210629003383 |
| Provider Name | Kerry H Sullivan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1093717548 PECOS PAC ID: 7012064611 Enrollment ID: I20210706000415 |
| Provider Name | Tariq Rashid |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497701619 PECOS PAC ID: 2466430863 Enrollment ID: I20210715001987 |
| Provider Name | Diane L Apalategui |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982293346 PECOS PAC ID: 3072918747 Enrollment ID: I20210818000860 |
| Provider Name | Teresa S Mcqueen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265819791 PECOS PAC ID: 3870801681 Enrollment ID: I20210818001608 |
| Provider Name | Carl N Schofield |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316945728 PECOS PAC ID: 5597727180 Enrollment ID: I20210818003507 |
| Provider Name | April E Byrd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396262127 PECOS PAC ID: 0749549350 Enrollment ID: I20210830000179 |
| Provider Name | Melissa Bartel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407827439 PECOS PAC ID: 8426007014 Enrollment ID: I20211123000291 |
| Provider Name | Kevin M Cawley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396761748 PECOS PAC ID: 4486829892 Enrollment ID: I20211208000233 |
| Provider Name | Richard C Wilson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134100589 PECOS PAC ID: 3678584364 Enrollment ID: I20211220000755 |
| Provider Name | Richard Jennis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891777975 PECOS PAC ID: 9739100801 Enrollment ID: I20211222000305 |
| Provider Name | Anne Marie Mclellan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548590813 PECOS PAC ID: 6800066291 Enrollment ID: I20211223000307 |
| Provider Name | Alix Hopp |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154770774 PECOS PAC ID: 8729356829 Enrollment ID: I20211230000469 |
| Provider Name | Thomas L Vesy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578563359 PECOS PAC ID: 8022263607 Enrollment ID: I20220103000955 |
| Provider Name | Joy D Foster |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063430320 PECOS PAC ID: 5991691529 Enrollment ID: I20220126000542 |
| Provider Name | Beth Ann Cureton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1245518653 PECOS PAC ID: 3577797026 Enrollment ID: I20220308000686 |
| Provider Name | Dennis L Buschman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841266418 PECOS PAC ID: 9830152321 Enrollment ID: I20220310001197 |
| Provider Name | Jill Wruble |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396717666 PECOS PAC ID: 3173515632 Enrollment ID: I20220310002409 |
| Provider Name | Michael P Dixon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1245264399 PECOS PAC ID: 7012948961 Enrollment ID: I20220311000535 |
| Provider Name | Logan C Bisset |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356760276 PECOS PAC ID: 9133411499 Enrollment ID: I20220317001529 |
| Provider Name | Donald R Anderson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609090026 PECOS PAC ID: 3577654938 Enrollment ID: I20220405000612 |
| Provider Name | Matthew Czar Taon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952796765 PECOS PAC ID: 7517242845 Enrollment ID: I20220420001005 |
| Provider Name | Nina Luscombe |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1790026482 PECOS PAC ID: 7517264138 Enrollment ID: I20220505000085 |
| Provider Name | Timothy M Erwin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508186784 PECOS PAC ID: 3072756345 Enrollment ID: I20220518002154 |
| Provider Name | Jeffrey Rein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760460323 PECOS PAC ID: 0941483580 Enrollment ID: I20220519001102 |
| Provider Name | Antonio I Fernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023181377 PECOS PAC ID: 9739283292 Enrollment ID: I20220728000008 |
| Provider Name | Karen A Reardon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013095827 PECOS PAC ID: 8921023706 Enrollment ID: I20220803000830 |
| Provider Name | Jeffrey A Duncan |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1669432365 PECOS PAC ID: 0648524454 Enrollment ID: I20220830001792 |
| Provider Name | Gabriela Santos Nunez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1710354352 PECOS PAC ID: 9638477581 Enrollment ID: I20220929002521 |
| Provider Name | Lacy Manuelito |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750844155 PECOS PAC ID: 3870820210 Enrollment ID: I20221005000749 |
| Provider Name | Pio Hocate |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487621900 PECOS PAC ID: 9436195385 Enrollment ID: I20221115000442 |
| Provider Name | Jawad Bilal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174939623 PECOS PAC ID: 2163773706 Enrollment ID: I20221207002358 |
| Provider Name | Gregory Parish |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912925389 PECOS PAC ID: 7214825728 Enrollment ID: I20221215000230 |
| Provider Name | Robert L Edwards |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023082542 PECOS PAC ID: 0547160202 Enrollment ID: I20230125001135 |
| Provider Name | William F Mills |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427045665 PECOS PAC ID: 1254410913 Enrollment ID: I20230310000239 |
| Provider Name | Merlin T Curry |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811334907 PECOS PAC ID: 0042514432 Enrollment ID: I20230322002440 |
| Provider Name | Teresa F Kestler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528155124 PECOS PAC ID: 5496753600 Enrollment ID: I20230330000198 |
| Provider Name | Dylan Harris Lee |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1184156713 PECOS PAC ID: 4880018324 Enrollment ID: I20230525001292 |
| Provider Name | Kristen Felan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255036547 PECOS PAC ID: 1850758954 Enrollment ID: I20230605003400 |
| Provider Name | Alyssa Katz |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1225726474 PECOS PAC ID: 6204294747 Enrollment ID: I20230615001644 |
| Provider Name | Mark A Bisesi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346208253 PECOS PAC ID: 6800788522 Enrollment ID: I20230620002227 |
| Provider Name | Anna M Weissmann |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083813638 PECOS PAC ID: 1456443977 Enrollment ID: I20230717002529 |
| Provider Name | Tomy Kalapparambath |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558388330 PECOS PAC ID: 3375547268 Enrollment ID: I20230818001753 |
| Provider Name | Tyrel Fisher |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457813578 PECOS PAC ID: 4688909591 Enrollment ID: I20230823000019 |
| Provider Name | Uhng Kyu R Shim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114016474 PECOS PAC ID: 3870483944 Enrollment ID: I20230823004481 |
| Provider Name | Vincent Campion |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1578096137 PECOS PAC ID: 9537582572 Enrollment ID: I20230825003122 |
| Provider Name | John D Lenahan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437713286 PECOS PAC ID: 1850634502 Enrollment ID: I20230905000311 |
| Provider Name | Samuel Cook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255990297 PECOS PAC ID: 2062817653 Enrollment ID: I20231017000497 |
| Provider Name | Michael Caruso |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114176906 PECOS PAC ID: 3779737812 Enrollment ID: I20231122000318 |
| Provider Name | Emma G Cortes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528553674 PECOS PAC ID: 5890140081 Enrollment ID: I20231219003287 |
| Provider Name | Benjamin Lee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538299334 PECOS PAC ID: 1456451525 Enrollment ID: I20240115000894 |
| Provider Name | Rona L Gazaway |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104916857 PECOS PAC ID: 7416992201 Enrollment ID: I20240125000691 |
| Provider Name | Gisele Cesar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780240044 PECOS PAC ID: 4385029750 Enrollment ID: I20240227002130 |
Ironwood Gastroenterology Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 395 N Silverbell Rd, Suite 255, Tucson, AZ 85745 Phone: 520-722-3777 Fax: 520-296-6224 | |
Sparcc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5199 E Farness Dr, Ste 101, Tucson, AZ 85712 Phone: 520-548-4847 Fax: 520-300-7156 | |
One Medical Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8616 E Broadway Blvd, Tucson, AZ 85710 Phone: 520-468-4809 Fax: 520-254-6016 | |
Total Care Health Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 941 N 11th Ave, Tucson, AZ 85705 Phone: 517-294-1835 | |
Omo Ije's'a Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7309 E 28th St, Tucson, AZ 85710 Phone: 510-345-8981 Fax: 520-253-7229 | |
James R Boyed Md Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6548 E Carondelet Dr Bldg E, Tucson, AZ 85710 Phone: 520-298-2319 Fax: 520-298-7811 | |
Northwest Allied Physicians Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2055 W Hospital Dr, Suite 205, Tucson, AZ 85704 Phone: 520-229-2563 Fax: 520-229-2561 |