| Sky Lakes Medical Center Inc | |
|
2865 Daggett Ave Klamath Falls OR 97601-1106 | |
| (541) 274-6221 | |
| (541) 274-6247 |
| Full Name | Sky Lakes Medical Center Inc |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 2865 Daggett Ave, Klamath Falls, Oregon |
| Authorized Official Name and Position | Richard E Rico (VP) |
| Authorized Official Contact | 5412746150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sky Lakes Medical Center Inc 2865 Daggett Ave Klamath Falls OR 97601-1106 Ph: (541) 274-6221 | Sky Lakes Medical Center Inc 2865 Daggett Ave Klamath Falls OR 97601-1106 Ph: (541) 274-6221 |
| NPI Number | 1659340370 |
|---|---|
| Provider Enumeration Date | 03/15/2006 |
| Last Update Date | 02/11/2010 |
| Medicare PECOS PAC ID | 1052204096 |
|---|---|
| Medicare Enrollment ID | O20040204000577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659340370 | NPI | - | NPPES |
| 01556 | Medicaid | OR | |
| 017881103 | Medicaid | OR | |
| 020406500A | Medicaid | OR | |
| 100457850A | Medicaid | OR | |
| 066167 | Medicaid | OR | |
| ZZR20101F | Medicaid | OR | |
| 152371 | Medicaid | OR | |
| 7126139 | Medicaid | OR | |
| 717315600 | Medicaid | OR | |
| 82508600 | Medicaid | OR | |
| HSP60101F | Medicaid | OR | |
| 011198 | Medicaid | OR | |
| 0033522 | Medicaid | OR | |
| 0413257 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 282N00000X | General Acute Care Hospital | 140724 (Oregon) | Primary |
| Provider Name | Wendy A Warren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992836472 PECOS PAC ID: 7113810151 Enrollment ID: I20040220001159 |
| Provider Name | Christopher Zoolkoski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275544892 PECOS PAC ID: 0648166736 Enrollment ID: I20040226000738 |
| Provider Name | Sharon K Heaton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033273255 PECOS PAC ID: 0648168716 Enrollment ID: I20040310000226 |
| Provider Name | George Kubac |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1114081700 PECOS PAC ID: 0042109688 Enrollment ID: I20040326000889 |
| Provider Name | John L Jacobson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508829748 PECOS PAC ID: 2668460494 Enrollment ID: I20040503000277 |
| Provider Name | J Eric Brunswick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902864275 PECOS PAC ID: 9739088840 Enrollment ID: I20040608000223 |
| Provider Name | Thao T P Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689609364 PECOS PAC ID: 2062497910 Enrollment ID: I20040623001048 |
| Provider Name | Kendall R Michels |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1891830139 PECOS PAC ID: 2163402462 Enrollment ID: I20040726000376 |
| Provider Name | Frank Geoffrey Marx |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942296678 PECOS PAC ID: 4385600071 Enrollment ID: I20041203000973 |
| Provider Name | Jeffrey W Chudoba |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104811322 PECOS PAC ID: 1850338609 Enrollment ID: I20050413000252 |
| Provider Name | Karl C Wenner |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1659393759 PECOS PAC ID: 1951395706 Enrollment ID: I20050506000699 |
| Provider Name | Vicky H Lee |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1740239342 PECOS PAC ID: 6103860747 Enrollment ID: I20050615000258 |
| Provider Name | Michael J Casey |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1285658187 PECOS PAC ID: 6305830159 Enrollment ID: I20050729000437 |
| Provider Name | Stephen B Kornfeld |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1164533667 PECOS PAC ID: 7517877996 Enrollment ID: I20050809000253 |
| Provider Name | Douglas Baldwin Hecox |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1235274564 PECOS PAC ID: 3577593870 Enrollment ID: I20050816001134 |
| Provider Name | Darcy R Butcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083614630 PECOS PAC ID: 0446282321 Enrollment ID: I20050831000818 |
| Provider Name | Edward L Vantassel |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1093737199 PECOS PAC ID: 5698768182 Enrollment ID: I20050913000487 |
| Provider Name | Alden B Glidden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386691897 PECOS PAC ID: 6709871684 Enrollment ID: I20050914000051 |
| Provider Name | Kevin O Lepard |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760403026 PECOS PAC ID: 5395637003 Enrollment ID: I20051014000630 |
| Provider Name | Dale S Mcdowell |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1477617686 PECOS PAC ID: 6204854284 Enrollment ID: I20051108000760 |
| Provider Name | Charles K Cofas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053371666 PECOS PAC ID: 0143259648 Enrollment ID: I20060413000484 |
| Provider Name | Jennifer Newton |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1568417194 PECOS PAC ID: 4880605138 Enrollment ID: I20060526000049 |
| Provider Name | Marc D Orlando |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1588605273 PECOS PAC ID: 4183636467 Enrollment ID: I20060705000218 |
| Provider Name | Nellie M Wirsing |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932129483 PECOS PAC ID: 7719983352 Enrollment ID: I20061004000644 |
| Provider Name | Donald J Venes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437166311 PECOS PAC ID: 4385642958 Enrollment ID: I20061114000337 |
| Provider Name | Sarah Ann Lamanuzzi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235243049 PECOS PAC ID: 9931114857 Enrollment ID: I20061204000523 |
| Provider Name | Bradley Kramer |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1144264201 PECOS PAC ID: 1557361466 Enrollment ID: I20061227000190 |
| Provider Name | Gabriel R Mayland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669586467 PECOS PAC ID: 6406864263 Enrollment ID: I20070102000116 |
| Provider Name | Bretton H Breazeale |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699883785 PECOS PAC ID: 9537160544 Enrollment ID: I20070117000534 |
| Provider Name | Lawrence L Cohen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871677641 PECOS PAC ID: 7618867029 Enrollment ID: I20070326000173 |
| Provider Name | Gregory P Schutt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366512857 PECOS PAC ID: 7315048857 Enrollment ID: I20070727000120 |
| Provider Name | Tina M Passalaris |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1508951864 PECOS PAC ID: 2961451711 Enrollment ID: I20070827000753 |
| Provider Name | Karl R Knudsen |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1730275736 PECOS PAC ID: 6901792373 Enrollment ID: I20070910000164 |
| Provider Name | Grant Niskanen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801898358 PECOS PAC ID: 2668463738 Enrollment ID: I20080212000273 |
| Provider Name | Melissa A Tolstikhine |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1770602880 PECOS PAC ID: 7618966730 Enrollment ID: I20080710000069 |
| Provider Name | Rastislav Kucinsky |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174787113 PECOS PAC ID: 4082789664 Enrollment ID: I20080815000412 |
| Provider Name | Richard H Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265440473 PECOS PAC ID: 1557420775 Enrollment ID: I20081103000596 |
| Provider Name | Radu C Moisa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053520023 PECOS PAC ID: 3072670090 Enrollment ID: I20090318000682 |
| Provider Name | Thomas R Brown |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033137278 PECOS PAC ID: 2860483765 Enrollment ID: I20090423000536 |
| Provider Name | Slavka Kucinska |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982698221 PECOS PAC ID: 8123059060 Enrollment ID: I20090623000721 |
| Provider Name | Dwight W Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033122734 PECOS PAC ID: 3678625027 Enrollment ID: I20090715000358 |
| Provider Name | Shaun Christopher Spalding |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154533248 PECOS PAC ID: 7113082942 Enrollment ID: I20090915000725 |
| Provider Name | Joseph N Pack |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578765012 PECOS PAC ID: 4688730062 Enrollment ID: I20090915000786 |
| Provider Name | Robert T Melton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770741027 PECOS PAC ID: 3476609546 Enrollment ID: I20090915000810 |
| Provider Name | Jakob F Freid |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477750347 PECOS PAC ID: 4082760152 Enrollment ID: I20090915000837 |
| Provider Name | Carl A Barbee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790723658 PECOS PAC ID: 7618925421 Enrollment ID: I20090918000141 |
| Provider Name | William Clay Mccord |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1891866786 PECOS PAC ID: 9931255221 Enrollment ID: I20090929000440 |
| Provider Name | Melissa R Sample |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922250364 PECOS PAC ID: 4183760424 Enrollment ID: I20090930000264 |
| Provider Name | Sophana Karnchanasorn |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1710165303 PECOS PAC ID: 6800933276 Enrollment ID: I20091019000102 |
| Provider Name | Atarah Sidey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811106891 PECOS PAC ID: 8426197880 Enrollment ID: I20091125000265 |
| Provider Name | William B West |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1548370869 PECOS PAC ID: 9931268596 Enrollment ID: I20100108000695 |
| Provider Name | Joanna B Narkiewicz-jodko |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1750445904 PECOS PAC ID: 1951443902 Enrollment ID: I20100128000821 |
| Provider Name | Dean P Raniele |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1851426241 PECOS PAC ID: 1153301460 Enrollment ID: I20100512000290 |
| Provider Name | Michele C Rushton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699943845 PECOS PAC ID: 2062544323 Enrollment ID: I20100722000070 |
| Provider Name | Jerri L Britsch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124161104 PECOS PAC ID: 7113017294 Enrollment ID: I20100929000832 |
| Provider Name | Randal A Machado |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225169840 PECOS PAC ID: 0446144026 Enrollment ID: I20100929000931 |
| Provider Name | John J Kleeman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861536435 PECOS PAC ID: 0749370823 Enrollment ID: I20101005000780 |
| Provider Name | Kenneth D Haugen |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1710946959 PECOS PAC ID: 2668548280 Enrollment ID: I20101104001245 |
| Provider Name | Mohamed Siyad |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1780862391 PECOS PAC ID: 1254525066 Enrollment ID: I20101104001356 |
| Provider Name | Nicolaas W De Wette |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1689677692 PECOS PAC ID: 6406949726 Enrollment ID: I20101112000412 |
| Provider Name | Marcus Paul Braun |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1235132309 PECOS PAC ID: 6800931304 Enrollment ID: I20101118000361 |
| Provider Name | Brandon D Chase |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730300815 PECOS PAC ID: 1254527377 Enrollment ID: I20101130001446 |
| Provider Name | Esteban Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346236478 PECOS PAC ID: 6709074529 Enrollment ID: I20101221000679 |
| Provider Name | Joyce Hollander-rodriguez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649219882 PECOS PAC ID: 6709075930 Enrollment ID: I20110104000780 |
| Provider Name | Robert Paul Jackman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922047612 PECOS PAC ID: 3678762812 Enrollment ID: I20110104000834 |
| Provider Name | Renu Gupta |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1609062439 PECOS PAC ID: 8527123868 Enrollment ID: I20110812000206 |
| Provider Name | Linda K Walker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1053467852 PECOS PAC ID: 7315978095 Enrollment ID: I20110823000171 |
| Provider Name | Stanton T Smith |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1518142967 PECOS PAC ID: 1658496021 Enrollment ID: I20110913000547 |
| Provider Name | Shelly L Thorpe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144500760 PECOS PAC ID: 3870765480 Enrollment ID: I20111004000171 |
| Provider Name | Katherine E Heinrich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568749844 PECOS PAC ID: 2365601853 Enrollment ID: I20120301000588 |
| Provider Name | Edward Trobaugh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194968800 PECOS PAC ID: 0042474298 Enrollment ID: I20120619000637 |
| Provider Name | Kristi M Coleman |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1659515336 PECOS PAC ID: 1052568391 Enrollment ID: I20120822000109 |
| Provider Name | Daniel Oliver Pederson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811130669 PECOS PAC ID: 2961659198 Enrollment ID: I20120823000410 |
| Provider Name | Scott M Allen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457508954 PECOS PAC ID: 5395992283 Enrollment ID: I20120828000804 |
| Provider Name | Sarah L Laiosa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124261862 PECOS PAC ID: 8820248644 Enrollment ID: I20121031000665 |
| Provider Name | Phoebe E Harvey |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1932386414 PECOS PAC ID: 9739357872 Enrollment ID: I20130221000518 |
| Provider Name | Debra C Hartley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720222771 PECOS PAC ID: 4688829740 Enrollment ID: I20130221000546 |
| Provider Name | George W Molzen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992890164 PECOS PAC ID: 0042376592 Enrollment ID: I20130522000203 |
| Provider Name | Kumar Pannagasayanam Dinesh |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1225222599 PECOS PAC ID: 6800034539 Enrollment ID: I20130607000299 |
| Provider Name | Ann Elisabeth Kellogg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619291127 PECOS PAC ID: 9436304367 Enrollment ID: I20130723000830 |
| Provider Name | Beverly H Bauman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1033279633 PECOS PAC ID: 5092810515 Enrollment ID: I20130806000152 |
| Provider Name | Ryan B Udink |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073756359 PECOS PAC ID: 0446400410 Enrollment ID: I20130912000310 |
| Provider Name | Laneah Lynn Snyder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174848519 PECOS PAC ID: 8921245945 Enrollment ID: I20130913000208 |
| Provider Name | Lindsey Gale Burwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871819243 PECOS PAC ID: 9032364625 Enrollment ID: I20130930000331 |
| Provider Name | Dean Gardella |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174667034 PECOS PAC ID: 9931363520 Enrollment ID: I20131002000218 |
| Provider Name | Andrea L Green |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1477620359 PECOS PAC ID: 6305887274 Enrollment ID: I20131106001056 |
| Provider Name | Jared M Ogao |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1962608067 PECOS PAC ID: 4183850258 Enrollment ID: I20131119001354 |
| Provider Name | Alba Virginia Schultz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801164926 PECOS PAC ID: 3173799392 Enrollment ID: I20131203001548 |
| Provider Name | Matthew G Thompson |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1841427366 PECOS PAC ID: 1557592623 Enrollment ID: I20140403000150 |
| Provider Name | Ronald T Barrett |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1285605097 PECOS PAC ID: 3870637531 Enrollment ID: I20140414000316 |
| Provider Name | Purvak Patel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528293842 PECOS PAC ID: 6709029481 Enrollment ID: I20140519002266 |
| Provider Name | Grace Hercl |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1376640011 PECOS PAC ID: 1850397506 Enrollment ID: I20140523000392 |
| Provider Name | Daniel Riesenberg |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1356317416 PECOS PAC ID: 4082698121 Enrollment ID: I20140625000537 |
| Provider Name | Heather Lea Dodds |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346431376 PECOS PAC ID: 6103980412 Enrollment ID: I20140919000423 |
| Provider Name | Holly L Montjoy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700177912 PECOS PAC ID: 6901043041 Enrollment ID: I20141002002605 |
| Provider Name | Kelly M Patterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235429069 PECOS PAC ID: 0840437984 Enrollment ID: I20141024002087 |
| Provider Name | Ana Marie V Ferguson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720407786 PECOS PAC ID: 1153542360 Enrollment ID: I20141031000000 |
| Provider Name | Karl Alu Tieva |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497044507 PECOS PAC ID: 3779705793 Enrollment ID: I20141106002055 |
| Provider Name | Karen Warren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538578067 PECOS PAC ID: 7517289762 Enrollment ID: I20141125002305 |
| Provider Name | Matthew Sean Edmonds |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629242854 PECOS PAC ID: 7719137710 Enrollment ID: I20141201002380 |
| Provider Name | Kema Kasalaba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023377397 PECOS PAC ID: 7416112784 Enrollment ID: I20141203001267 |
| Provider Name | Katherine S Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730479833 PECOS PAC ID: 3274788864 Enrollment ID: I20150116000255 |
| Provider Name | Gia M Seutter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144523093 PECOS PAC ID: 4486979184 Enrollment ID: I20150220000149 |
| Provider Name | Natasa C Jenson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083905111 PECOS PAC ID: 3375860869 Enrollment ID: I20150320001691 |
| Provider Name | Rinnah Macvittie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417346552 PECOS PAC ID: 3072830249 Enrollment ID: I20150327000203 |
| Provider Name | Rebecca Samet |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477509503 PECOS PAC ID: 8729012943 Enrollment ID: I20150623000844 |
| Provider Name | Abdulmetin Dursun |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679867071 PECOS PAC ID: 6608195631 Enrollment ID: I20150831000841 |
| Provider Name | Christopher J Baumann |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356585665 PECOS PAC ID: 5698082477 Enrollment ID: I20150910001566 |
| Provider Name | Carolyn M Pierce |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912299132 PECOS PAC ID: 4183844897 Enrollment ID: I20150923000645 |
| Provider Name | Brock T Trejo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841556099 PECOS PAC ID: 1557516366 Enrollment ID: I20150930002628 |
| Provider Name | David M Souza |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1083920177 PECOS PAC ID: 1254649783 Enrollment ID: I20151002002102 |
| Provider Name | Laurentiu Istrate |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437416179 PECOS PAC ID: 5597990630 Enrollment ID: I20151006003088 |
| Provider Name | Angus Y Ng |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053355198 PECOS PAC ID: 7416996582 Enrollment ID: I20151009001039 |
| Provider Name | Laura M Marchelya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477976702 PECOS PAC ID: 9133343213 Enrollment ID: I20151030000697 |
| Provider Name | Hesham A Elmergawy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811246176 PECOS PAC ID: 6709196215 Enrollment ID: I20151113000405 |
| Provider Name | Amit K Mehta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740544360 PECOS PAC ID: 4486954716 Enrollment ID: I20151118001436 |
| Provider Name | David Chadbourne |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1740277011 PECOS PAC ID: 4880612134 Enrollment ID: I20151124002415 |
| Provider Name | Elizabeth J Gualandi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962720649 PECOS PAC ID: 4284890658 Enrollment ID: I20151217000488 |
| Provider Name | Bonnie J Kerr |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1235241548 PECOS PAC ID: 5991988123 Enrollment ID: I20160126002060 |
| Provider Name | Francesco D Alessandro |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1457354136 PECOS PAC ID: 5799745410 Enrollment ID: I20160420000490 |
| Provider Name | Joseph Alexander Rutz |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1023195310 PECOS PAC ID: 8325103526 Enrollment ID: I20160429000884 |
| Provider Name | Gurleen Dhami |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1235422023 PECOS PAC ID: 0648596379 Enrollment ID: I20160914002501 |
| Provider Name | Rebecca Duby |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427477579 PECOS PAC ID: 6406074103 Enrollment ID: I20160929001397 |
| Provider Name | Jason Yost |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932544632 PECOS PAC ID: 6406080548 Enrollment ID: I20161004001642 |
| Provider Name | Jay T Williams |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831532118 PECOS PAC ID: 9830487339 Enrollment ID: I20161017001909 |
| Provider Name | Kasey Diane Gregory |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912240854 PECOS PAC ID: 9032497342 Enrollment ID: I20161020001175 |
| Provider Name | Anh Thi Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124461462 PECOS PAC ID: 7012141468 Enrollment ID: I20161021002125 |
| Provider Name | Makary Thomas Hofmann |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1801239868 PECOS PAC ID: 3678716883 Enrollment ID: I20161024001555 |
| Provider Name | Traci Nichole Gansberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336692813 PECOS PAC ID: 5092094961 Enrollment ID: I20161116002250 |
| Provider Name | Steven D Paul |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467417725 PECOS PAC ID: 4082630660 Enrollment ID: I20161215002124 |
| Provider Name | Haitham Shaheen |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1467764050 PECOS PAC ID: 2062701618 Enrollment ID: I20170117002333 |
| Provider Name | Yetunde O Akins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225317100 PECOS PAC ID: 6608177621 Enrollment ID: I20170118001132 |
| Provider Name | Jennifer L Hissett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699040824 PECOS PAC ID: 7113228297 Enrollment ID: I20170323002109 |
| Provider Name | Ladonna D Reyka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710219241 PECOS PAC ID: 9335323849 Enrollment ID: I20170412001632 |
| Provider Name | Sandra V Hazra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215972195 PECOS PAC ID: 3577464346 Enrollment ID: I20170425000080 |
| Provider Name | Anne B Pelletier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912285099 PECOS PAC ID: 7113194101 Enrollment ID: I20170512002057 |
| Provider Name | George Zhongshan Wang |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1982655403 PECOS PAC ID: 5597832824 Enrollment ID: I20170615001053 |
| Provider Name | Kelly Lueck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578815809 PECOS PAC ID: 3779728043 Enrollment ID: I20170810002684 |
| Provider Name | Lisa M Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831422336 PECOS PAC ID: 5193864395 Enrollment ID: I20170818001266 |
| Provider Name | Priscilla Villarreal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144648031 PECOS PAC ID: 3678884525 Enrollment ID: I20170825003080 |
| Provider Name | Jean Mccalmont |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376098681 PECOS PAC ID: 6800160649 Enrollment ID: I20170918003548 |
| Provider Name | Duane Charles Wilson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780664664 PECOS PAC ID: 0345137907 Enrollment ID: I20171005002050 |
| Provider Name | Gordon S Mccreadie |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1447314570 PECOS PAC ID: 0749272110 Enrollment ID: I20171006002033 |
| Provider Name | Stewart Decker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417375015 PECOS PAC ID: 8325267917 Enrollment ID: I20171102003482 |
| Provider Name | Lisa Marie Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952778086 PECOS PAC ID: 9234439068 Enrollment ID: I20171117002951 |
| Provider Name | Gheorghe Ciprian Cazan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801151568 PECOS PAC ID: 3274849914 Enrollment ID: I20171218000038 |
| Provider Name | Beata Sims |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497159347 PECOS PAC ID: 7214159763 Enrollment ID: I20180125003123 |
| Provider Name | Irina Iacobucci |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679990048 PECOS PAC ID: 3678791639 Enrollment ID: I20180126002379 |
| Provider Name | Connor Burke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841610656 PECOS PAC ID: 3971720244 Enrollment ID: I20180131002402 |
| Provider Name | Anne Marie Kessler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003236811 PECOS PAC ID: 0547489973 Enrollment ID: I20180315000785 |
| Provider Name | Brady William Sweat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003322330 PECOS PAC ID: 6002985876 Enrollment ID: I20180326000435 |
| Provider Name | Rita Goehring |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962883140 PECOS PAC ID: 4688950009 Enrollment ID: I20180406000480 |
| Provider Name | William G Utley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790026490 PECOS PAC ID: 1759646896 Enrollment ID: I20180521001306 |
| Provider Name | Lien Ly |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023458783 PECOS PAC ID: 7416267570 Enrollment ID: I20180619003118 |
| Provider Name | Rachel Emily Bailey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821264979 PECOS PAC ID: 2860566163 Enrollment ID: I20180712003573 |
| Provider Name | Brett A Magner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356736417 PECOS PAC ID: 9032418058 Enrollment ID: I20180725002944 |
| Provider Name | Lindsey Fox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629588504 PECOS PAC ID: 0941567721 Enrollment ID: I20180802001724 |
| Provider Name | Stephanie A Laudert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548600208 PECOS PAC ID: 2769762798 Enrollment ID: I20180827001106 |
| Provider Name | Danish Mirza |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184005332 PECOS PAC ID: 7517218118 Enrollment ID: I20180920002052 |
| Provider Name | Masayo Ozaki |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932594082 PECOS PAC ID: 0345593166 Enrollment ID: I20181024003374 |
| Provider Name | Amr R Hassan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366489569 PECOS PAC ID: 6800803966 Enrollment ID: I20181026001231 |
| Provider Name | Erin L Gonzales |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801282462 PECOS PAC ID: 2264722784 Enrollment ID: I20181130000063 |
| Provider Name | Jonathan Spicher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558758615 PECOS PAC ID: 4688955206 Enrollment ID: I20181210000360 |
| Provider Name | Shahin J Korangy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770679466 PECOS PAC ID: 5890714885 Enrollment ID: I20190104000799 |
| Provider Name | Monna Lee Alwine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215415708 PECOS PAC ID: 8729325238 Enrollment ID: I20190122002467 |
| Provider Name | Scott Edward Potenta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073808101 PECOS PAC ID: 8628371200 Enrollment ID: I20190212001279 |
| Provider Name | Mark Thomas Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558674796 PECOS PAC ID: 7618134073 Enrollment ID: I20190219001529 |
| Provider Name | Aimee Leigh Rowe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255769857 PECOS PAC ID: 6002196086 Enrollment ID: I20190227002007 |
| Provider Name | Priscilla Kim Codiga |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1629009402 PECOS PAC ID: 7315926979 Enrollment ID: I20190301002403 |
| Provider Name | Michael Drew Duffin |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1578587309 PECOS PAC ID: 3072555390 Enrollment ID: I20190328002997 |
| Provider Name | Yolanda Straughter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861837007 PECOS PAC ID: 8123260171 Enrollment ID: I20190401002236 |
| Provider Name | Kimberly Kinder |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1376705111 PECOS PAC ID: 4183868193 Enrollment ID: I20190403002805 |
| Provider Name | Christopher D Barton |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1699001073 PECOS PAC ID: 3274709597 Enrollment ID: I20190405001341 |
| Provider Name | Julie M Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750850327 PECOS PAC ID: 3971844549 Enrollment ID: I20190408002811 |
| Provider Name | Kathryn A Leavitt |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1467871277 PECOS PAC ID: 8426272824 Enrollment ID: I20190603000418 |
| Provider Name | Siamak Karimian |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1225091812 PECOS PAC ID: 7719933258 Enrollment ID: I20190610002861 |
| Provider Name | Aurora Hoyle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124527809 PECOS PAC ID: 0941551352 Enrollment ID: I20190611003210 |
| Provider Name | Brian John Goldsmith |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1033117452 PECOS PAC ID: 9739107889 Enrollment ID: I20190709001026 |
| Provider Name | John Dwight Seidner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881637148 PECOS PAC ID: 5799790895 Enrollment ID: I20190716000615 |
| Provider Name | Jennifer Renee Wise |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255326252 PECOS PAC ID: 9830106202 Enrollment ID: I20190716002141 |
| Provider Name | Margaret Anna Jolley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689019853 PECOS PAC ID: 5294040549 Enrollment ID: I20190903000753 |
| Provider Name | Dallas Swanson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699115550 PECOS PAC ID: 6507144987 Enrollment ID: I20190912001861 |
| Provider Name | Nathan G Miller |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1265728166 PECOS PAC ID: 5294021606 Enrollment ID: I20190917000391 |
| Provider Name | Maria Joana Angeles Thomas |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1205241122 PECOS PAC ID: 2769712678 Enrollment ID: I20190919000615 |
| Provider Name | Sarah Woodman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1295175297 PECOS PAC ID: 9739453887 Enrollment ID: I20191030001637 |
| Provider Name | Brendan J Fowler |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609225283 PECOS PAC ID: 2062708308 Enrollment ID: I20191202000178 |
| Provider Name | Leslie Ann Driggers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992355770 PECOS PAC ID: 5395179287 Enrollment ID: I20191231001724 |
| Provider Name | Michael J Walker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942640776 PECOS PAC ID: 9931446556 Enrollment ID: I20200130002564 |
| Provider Name | Julie A Phillips |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316074446 PECOS PAC ID: 6002978707 Enrollment ID: I20200227002751 |
| Provider Name | Jessica Sweetser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891329330 PECOS PAC ID: 0648609156 Enrollment ID: I20200404000551 |
| Provider Name | Derek Harpole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235771874 PECOS PAC ID: 3779914965 Enrollment ID: I20200501001739 |
| Provider Name | Danny Dwayne Tudor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225485485 PECOS PAC ID: 6800188053 Enrollment ID: I20200713002544 |
| Provider Name | Danielle Smestad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114494705 PECOS PAC ID: 5597009118 Enrollment ID: I20200821002071 |
| Provider Name | Maria Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174043517 PECOS PAC ID: 7315203833 Enrollment ID: I20200902003038 |
| Provider Name | Oriana Cruz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043794969 PECOS PAC ID: 4789925371 Enrollment ID: I20200916002381 |
| Provider Name | Matthew A Peters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912439506 PECOS PAC ID: 1052684990 Enrollment ID: I20200930003587 |
| Provider Name | Hannah Jantzi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811420409 PECOS PAC ID: 9234402454 Enrollment ID: I20201013001054 |
| Provider Name | Natalia A Hidden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831640317 PECOS PAC ID: 0648553289 Enrollment ID: I20201222002794 |
| Provider Name | Deepika Wali |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1144205295 PECOS PAC ID: 9032155973 Enrollment ID: I20210128003128 |
| Provider Name | Bobijo Staffler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962001586 PECOS PAC ID: 5193130433 Enrollment ID: I20210218000467 |
| Provider Name | Dennis Beckworth |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1265460661 PECOS PAC ID: 9335038983 Enrollment ID: I20210303001751 |
| Provider Name | Harold Levine |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649404849 PECOS PAC ID: 3476723099 Enrollment ID: I20210412000657 |
| Provider Name | Melanie Helene Clark |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164692711 PECOS PAC ID: 5294805503 Enrollment ID: I20210619000093 |
| Provider Name | James L Murray |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1205935079 PECOS PAC ID: 7911042130 Enrollment ID: I20210621001929 |
| Provider Name | Alia Abida Ashraf |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1699165944 PECOS PAC ID: 1658640180 Enrollment ID: I20210706001177 |
| Provider Name | Alex Eldon Peterson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528553054 PECOS PAC ID: 7416354493 Enrollment ID: I20210917000000 |
| Provider Name | Margo Debra Roemeling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285130427 PECOS PAC ID: 2163857665 Enrollment ID: I20210917002892 |
| Provider Name | William Krause |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1659395697 PECOS PAC ID: 5193711224 Enrollment ID: I20211021002798 |
| Provider Name | Roger Piepenbrink |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1962411470 PECOS PAC ID: 9739178013 Enrollment ID: I20211028001968 |
| Provider Name | Melissa Merrigan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871114306 PECOS PAC ID: 0749679389 Enrollment ID: I20211119000868 |
| Provider Name | Cassandra Cross |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962939967 PECOS PAC ID: 3072885680 Enrollment ID: I20211203002654 |
| Provider Name | Jennifer Fleischer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699271924 PECOS PAC ID: 5193115822 Enrollment ID: I20211210001984 |
| Provider Name | Aaron J Kramer |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1861843625 PECOS PAC ID: 9931494473 Enrollment ID: I20211215002444 |
| Provider Name | Joshua O Ness |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073019220 PECOS PAC ID: 1153678933 Enrollment ID: I20211228002003 |
| Provider Name | Hyung Chil Kang |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1992709471 PECOS PAC ID: 5294724514 Enrollment ID: I20211228002134 |
| Provider Name | Keith R Mills |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1053400598 PECOS PAC ID: 8921094020 Enrollment ID: I20220207001706 |
| Provider Name | Kevin Thomas Scheppke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609004068 PECOS PAC ID: 9234394545 Enrollment ID: I20220214002183 |
| Provider Name | Kirsten Balin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538812979 PECOS PAC ID: 6204215429 Enrollment ID: I20220617002610 |
| Provider Name | Lawrence Carlson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1639188972 PECOS PAC ID: 6709826159 Enrollment ID: I20220622002783 |
| Provider Name | Anna Sokolowski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598057200 PECOS PAC ID: 3678890811 Enrollment ID: I20220803001630 |
| Provider Name | Nicholas Bennett West |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326508631 PECOS PAC ID: 5890038590 Enrollment ID: I20220804001775 |
| Provider Name | Ami Patel |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1932583853 PECOS PAC ID: 7416235718 Enrollment ID: I20220811002884 |
| Provider Name | Sanjay Jain |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1730130105 PECOS PAC ID: 7911804968 Enrollment ID: I20220812001470 |
| Provider Name | Saige E Kubac |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407317647 PECOS PAC ID: 6305279373 Enrollment ID: I20220929002481 |
| Provider Name | Mitzi A Garrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730150749 PECOS PAC ID: 5890750228 Enrollment ID: I20221004001883 |
| Provider Name | Kieran F Kubac |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114487741 PECOS PAC ID: 0941537518 Enrollment ID: I20221012002223 |
| Provider Name | Joel Klas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356800460 PECOS PAC ID: 8527397819 Enrollment ID: I20221013002721 |
| Provider Name | Kayla Marie Culp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609500321 PECOS PAC ID: 6406222371 Enrollment ID: I20221018000732 |
| Provider Name | Logan Bruttig |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568020246 PECOS PAC ID: 2163898081 Enrollment ID: I20221018002831 |
| Provider Name | Sarah Wonn |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1861854754 PECOS PAC ID: 5698061307 Enrollment ID: I20221025001521 |
| Provider Name | Kimberly Walker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750961488 PECOS PAC ID: 5890103139 Enrollment ID: I20221027003004 |
| Provider Name | Ahmad Ali |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326595224 PECOS PAC ID: 8729341052 Enrollment ID: I20221121000963 |
| Provider Name | Mona Batra |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1053304634 PECOS PAC ID: 1658319876 Enrollment ID: I20221121002302 |
| Provider Name | Sidra Iftikhar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457912966 PECOS PAC ID: 5092186858 Enrollment ID: I20230116000011 |
| Provider Name | Madeline Boyd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083167118 PECOS PAC ID: 1355776469 Enrollment ID: I20230124002787 |
| Provider Name | Robyn Ewing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093422321 PECOS PAC ID: 1951772813 Enrollment ID: I20230201000593 |
| Provider Name | Michaela Marie Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881322360 PECOS PAC ID: 6901277896 Enrollment ID: I20230201002347 |
| Provider Name | Robert Goebel |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1174620504 PECOS PAC ID: 6608787809 Enrollment ID: I20230206001133 |
| Provider Name | Shannon Lee Galpin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083341903 PECOS PAC ID: 0749652436 Enrollment ID: I20230206002291 |
| Provider Name | Robert E Love |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1952676157 PECOS PAC ID: 7113229543 Enrollment ID: I20230220000684 |
| Provider Name | Desirae Rathbone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720721392 PECOS PAC ID: 1951789320 Enrollment ID: I20230220001761 |
| Provider Name | Kim N Bagby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235672726 PECOS PAC ID: 8426317058 Enrollment ID: I20230227001084 |
| Provider Name | Jaci Marie Mastrandrea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528779444 PECOS PAC ID: 9739553595 Enrollment ID: I20230316002769 |
| Provider Name | Mohammad Hissourou |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1538664057 PECOS PAC ID: 7911241674 Enrollment ID: I20230424002711 |
| Provider Name | Jordan Hoese |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184184962 PECOS PAC ID: 2466781745 Enrollment ID: I20230503002872 |
| Provider Name | Christina Marie Harvey-brunswick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154022705 PECOS PAC ID: 2163887571 Enrollment ID: I20230508000427 |
| Provider Name | Susan W Feeney |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1750321469 PECOS PAC ID: 7012929466 Enrollment ID: I20230509000725 |
| Provider Name | Ming Zeng |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1275522435 PECOS PAC ID: 4789768912 Enrollment ID: I20230515001025 |
| Provider Name | Hans H Kim |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1750885687 PECOS PAC ID: 1254681448 Enrollment ID: I20230607003106 |
| Provider Name | Jaimee Jo Bierhaus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174825517 PECOS PAC ID: 8224496047 Enrollment ID: I20230626002660 |
| Provider Name | Christopher Sean Haling |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417061482 PECOS PAC ID: 0941303366 Enrollment ID: I20230711001342 |
| Provider Name | Jared D Schaefer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447888193 PECOS PAC ID: 8921421207 Enrollment ID: I20230718002796 |
| Provider Name | Sara J Malzacher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023616877 PECOS PAC ID: 5395106587 Enrollment ID: I20230803004119 |
| Provider Name | Teresa Neprud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386636603 PECOS PAC ID: 0042476509 Enrollment ID: I20230810001324 |
| Provider Name | Gulreen A Kassoo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1851928006 PECOS PAC ID: 6507277951 Enrollment ID: I20230817001204 |
| Provider Name | Jessica L Visser |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1912249756 PECOS PAC ID: 6901185784 Enrollment ID: I20230818002523 |
| Provider Name | Carlos N Hernandez Torres |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871723171 PECOS PAC ID: 8820253693 Enrollment ID: I20230915002301 |
| Provider Name | Logan Smestad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629606322 PECOS PAC ID: 5294158507 Enrollment ID: I20231007000232 |
| Provider Name | Angela Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932480365 PECOS PAC ID: 5597915447 Enrollment ID: I20231010000227 |
| Provider Name | Brittany N Cox |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104453463 PECOS PAC ID: 0244651750 Enrollment ID: I20231016003232 |
| Provider Name | John Sacco |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1336133685 PECOS PAC ID: 7214849686 Enrollment ID: I20231017001897 |
| Provider Name | Tejwant Dhillon |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1356395800 PECOS PAC ID: 8022069715 Enrollment ID: I20231023003626 |
| Provider Name | Zenaida Lucas Gabriel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407433626 PECOS PAC ID: 1759738925 Enrollment ID: I20231109000626 |
| Provider Name | Cole Puffer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669009924 PECOS PAC ID: 5698199461 Enrollment ID: I20231122001747 |
| Provider Name | Neysi J Anderson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124681374 PECOS PAC ID: 7113302886 Enrollment ID: I20231130003117 |
| Provider Name | Karli B Stoller-hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528748910 PECOS PAC ID: 6305295593 Enrollment ID: I20231213002251 |
| Provider Name | Steven R Debiase |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184252355 PECOS PAC ID: 1951762814 Enrollment ID: I20231215002589 |
| Provider Name | Nadia Mostovych |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1861752180 PECOS PAC ID: 7517190473 Enrollment ID: I20231218001156 |
| Provider Name | Nancy Ferrer Barr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821696816 PECOS PAC ID: 8022468990 Enrollment ID: I20231219002715 |
| Provider Name | Carolyn Ann Hennessey |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1003048141 PECOS PAC ID: 3375994783 Enrollment ID: I20240110003172 |
| Provider Name | Sharon Kaur Grewal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831719624 PECOS PAC ID: 1254720808 Enrollment ID: I20240208000703 |
Cofas Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2218 Shallock Ave, Klamath Falls, OR 97601 Phone: 541-882-3818 Fax: 541-882-9800 | |
Sky Lakes Medical Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2600 Clover St, Klamath Falls, OR 97601 Phone: 541-274-6221 | |
Baby Catchers And Company, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1900 Main St, Suite B, Klamath Falls, OR 97601 Phone: 541-887-8321 Fax: 541-887-8322 | |
Basin Immediate Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3737 Shasta Way Ste A, Klamath Falls, OR 97603 Phone: 541-883-2337 Fax: 541-883-2504 | |
Sky Lakes Medical Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2617 Almond St, Klamath Falls, OR 97601 Phone: 541-274-6221 | |
Whole Person Care Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2301 Mountainview Blvd. Ste B, Klamath Falls, OR 97601 Phone: 541-850-7697 Fax: 541-884-1580 | |
Aspen Family Medicine P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2631 Crosby Ave, Klamath Falls, OR 97603 Phone: 541-884-2900 Fax: 541-884-5204 |