| St. Charles Medical Group | |
|
2500 Ne Neff Rd Bend OR 97701-6015 | |
| (541) 382-4321 | |
| Not Available |
| Full Name | St. Charles Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 2500 Ne Neff Rd, Bend, Oregon |
| Authorized Official Name and Position | Matthew Swafford (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5413824321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Charles Medical Group Po Box 6095 Bend OR 97708-6095 Ph: (541) 382-4321 | St. Charles Medical Group 2500 Ne Neff Rd Bend OR 97701-6015 Ph: (541) 382-4321 |
| NPI Number | 1023331303 |
|---|---|
| Provider Enumeration Date | 03/01/2010 |
| Last Update Date | 05/05/2023 |
| Medicare PECOS PAC ID | 8729111513 |
|---|---|
| Medicare Enrollment ID | O20100730000227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023331303 | NPI | - | NPPES |
| 500625168 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Eddy K Young |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1710967633 PECOS PAC ID: 8426961418 Enrollment ID: I20031111000506 |
| Provider Name | Hugh R Adair |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1700866746 PECOS PAC ID: 4587577572 Enrollment ID: I20031111000629 |
| Provider Name | Bruce A Mclellan |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1043290398 PECOS PAC ID: 4981517976 Enrollment ID: I20031111000825 |
| Provider Name | Linda Craska Selby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831165232 PECOS PAC ID: 3971409939 Enrollment ID: I20031210000429 |
| Provider Name | Gary P Foster |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1730192378 PECOS PAC ID: 9133027642 Enrollment ID: I20031222000551 |
| Provider Name | Joseph W Flannery |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134250566 PECOS PAC ID: 9133112246 Enrollment ID: I20040405001807 |
| Provider Name | Thomas L Allumbaugh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114959210 PECOS PAC ID: 1850384488 Enrollment ID: I20040407001313 |
| Provider Name | Gayle E Briggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639114028 PECOS PAC ID: 8729075098 Enrollment ID: I20040428000959 |
| Provider Name | Ricardo Garza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467569731 PECOS PAC ID: 2961473780 Enrollment ID: I20040804001507 |
| Provider Name | Jennifer C Neahring |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1134228950 PECOS PAC ID: 0547178576 Enrollment ID: I20040915000968 |
| Provider Name | Andrew W Adamski |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306874011 PECOS PAC ID: 2668436981 Enrollment ID: I20041116001272 |
| Provider Name | Lester J Dixon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609803865 PECOS PAC ID: 4183681851 Enrollment ID: I20041214000698 |
| Provider Name | John C Land |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1649228131 PECOS PAC ID: 3072508894 Enrollment ID: I20050328000036 |
| Provider Name | Michael T Lavelle |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1881635779 PECOS PAC ID: 7113968934 Enrollment ID: I20050520000967 |
| Provider Name | Andrew T Chen |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1124081096 PECOS PAC ID: 9931131471 Enrollment ID: I20050906001073 |
| Provider Name | Daniel S Hagg |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1710084587 PECOS PAC ID: 0648205872 Enrollment ID: I20050927000910 |
| Provider Name | William G Martin |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1356329106 PECOS PAC ID: 9537189949 Enrollment ID: I20051130000673 |
| Provider Name | Luann M Lehnertz |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1417160813 PECOS PAC ID: 8022030733 Enrollment ID: I20051222000034 |
| Provider Name | Michelle A Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841277480 PECOS PAC ID: 2163439241 Enrollment ID: I20060314000780 |
| Provider Name | Jonathan Schultz |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1740385863 PECOS PAC ID: 0244261469 Enrollment ID: I20061017000003 |
| Provider Name | Joe Thomas Mccook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154344869 PECOS PAC ID: 3072518422 Enrollment ID: I20070227000330 |
| Provider Name | Lynne M Oldham |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1235161928 PECOS PAC ID: 4082718333 Enrollment ID: I20070327000466 |
| Provider Name | Jennifer M Watters |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1801013560 PECOS PAC ID: 5597856393 Enrollment ID: I20070808000593 |
| Provider Name | James C Laughlin |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1679775639 PECOS PAC ID: 1951492446 Enrollment ID: I20070813000722 |
| Provider Name | Albert J Lilly |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285677955 PECOS PAC ID: 2860424090 Enrollment ID: I20071108000291 |
| Provider Name | Brooke Tate Hall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952342636 PECOS PAC ID: 2769411081 Enrollment ID: I20071116000521 |
| Provider Name | Laura K Mavity |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1043395890 PECOS PAC ID: 6204917552 Enrollment ID: I20080114000112 |
| Provider Name | Maggie J King |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457441586 PECOS PAC ID: 4880770197 Enrollment ID: I20080327000197 |
| Provider Name | Steven J Michel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841268729 PECOS PAC ID: 6608812532 Enrollment ID: I20080515000567 |
| Provider Name | Russ T K Omizo |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1770571556 PECOS PAC ID: 3971534884 Enrollment ID: I20080603000408 |
| Provider Name | Linyee J Chang |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1467436147 PECOS PAC ID: 7810068947 Enrollment ID: I20080618000192 |
| Provider Name | Ngocthuy Hughes |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1952501678 PECOS PAC ID: 6204908510 Enrollment ID: I20080702000064 |
| Provider Name | Saurabh Gupta |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1902873177 PECOS PAC ID: 5890749899 Enrollment ID: I20080711000504 |
| Provider Name | Matthew S Slater |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1487662912 PECOS PAC ID: 9436217494 Enrollment ID: I20081020000232 |
| Provider Name | Jessica A Nelson |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1245362599 PECOS PAC ID: 1658327689 Enrollment ID: I20081028000555 |
| Provider Name | William P Irvine |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265659510 PECOS PAC ID: 1850485418 Enrollment ID: I20081124000595 |
| Provider Name | Nathan R Thompson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124287321 PECOS PAC ID: 8022182658 Enrollment ID: I20100630000843 |
| Provider Name | Pamela J Irby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295773901 PECOS PAC ID: 4385639137 Enrollment ID: I20100802000222 |
| Provider Name | Robin L Lannan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467401273 PECOS PAC ID: 8729104146 Enrollment ID: I20100923000039 |
| Provider Name | Brant D Wommack |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023164613 PECOS PAC ID: 7911050877 Enrollment ID: I20101025001081 |
| Provider Name | Deborah L Rief-adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174840391 PECOS PAC ID: 2365638525 Enrollment ID: I20101130000634 |
| Provider Name | Nancy L Brennan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396725834 PECOS PAC ID: 5294921292 Enrollment ID: I20101201001123 |
| Provider Name | Robert George Ross |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811923774 PECOS PAC ID: 1759484561 Enrollment ID: I20110208000169 |
| Provider Name | Neil D Lancefield |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134392962 PECOS PAC ID: 9638348121 Enrollment ID: I20110818000465 |
| Provider Name | Noreen C Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144550237 PECOS PAC ID: 8921270299 Enrollment ID: I20111010000287 |
| Provider Name | David M Carne |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1811190622 PECOS PAC ID: 2466624523 Enrollment ID: I20111013000488 |
| Provider Name | Meghan G Brecke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245490606 PECOS PAC ID: 2668647652 Enrollment ID: I20111201000724 |
| Provider Name | Jeffrey R Mathisen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1740200484 PECOS PAC ID: 7416992508 Enrollment ID: I20120110000835 |
| Provider Name | Heidi Ann Allen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245406008 PECOS PAC ID: 1658548961 Enrollment ID: I20120126000615 |
| Provider Name | Carey Lee Allen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770740094 PECOS PAC ID: 9537328646 Enrollment ID: I20120309000067 |
| Provider Name | Kristin E Berry |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1306036314 PECOS PAC ID: 2264692078 Enrollment ID: I20120330000560 |
| Provider Name | Carol A Craig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437458940 PECOS PAC ID: 3274797493 Enrollment ID: I20120619000246 |
| Provider Name | Jacoby L Allen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396068748 PECOS PAC ID: 6103072079 Enrollment ID: I20120808000581 |
| Provider Name | Jake M Waits |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093982845 PECOS PAC ID: 6002084241 Enrollment ID: I20120820001079 |
| Provider Name | Matthew P Clausen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164664553 PECOS PAC ID: 6709035934 Enrollment ID: I20121004000092 |
| Provider Name | Erin E Schneider |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982864724 PECOS PAC ID: 4587842182 Enrollment ID: I20121207000148 |
| Provider Name | Angelina M Zamboni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669628822 PECOS PAC ID: 7911151675 Enrollment ID: I20130205000007 |
| Provider Name | Mark Goodman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609018860 PECOS PAC ID: 2668643008 Enrollment ID: I20130215000251 |
| Provider Name | Brian L Erickson |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1730168972 PECOS PAC ID: 0547369035 Enrollment ID: I20130312000000 |
| Provider Name | Heather L Hansen Dispenza |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1245283605 PECOS PAC ID: 8022013580 Enrollment ID: I20130611000819 |
| Provider Name | Jeremy T Johnson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1144415233 PECOS PAC ID: 7416045448 Enrollment ID: I20140213001159 |
| Provider Name | Jennifer Rossi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386832442 PECOS PAC ID: 6709073224 Enrollment ID: I20140514001228 |
| Provider Name | Jennifer Guthrie |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1437575149 PECOS PAC ID: 5092938779 Enrollment ID: I20140527001911 |
| Provider Name | Daniel Sedehi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1568644524 PECOS PAC ID: 8224191234 Enrollment ID: I20140616002471 |
| Provider Name | Matthew T Snodgrass |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932469335 PECOS PAC ID: 7810138195 Enrollment ID: I20140716000860 |
| Provider Name | Allen Rafael |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1962408526 PECOS PAC ID: 0648351825 Enrollment ID: I20141215002545 |
| Provider Name | Fredric L Tietz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467486829 PECOS PAC ID: 0446151609 Enrollment ID: I20150109002232 |
| Provider Name | Aimee M Neill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770801235 PECOS PAC ID: 4486891132 Enrollment ID: I20150110000017 |
| Provider Name | Jinnell A Lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740570266 PECOS PAC ID: 4284889122 Enrollment ID: I20150113001207 |
| Provider Name | Natalie T Good |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467731232 PECOS PAC ID: 5890944995 Enrollment ID: I20150113001386 |
| Provider Name | Katherine S Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730479833 PECOS PAC ID: 3274788864 Enrollment ID: I20150116000255 |
| Provider Name | Hannah B Boomer |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1992057491 PECOS PAC ID: 2062723356 Enrollment ID: I20150611003471 |
| Provider Name | Melissa T Gunasekera |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1417129925 PECOS PAC ID: 6103094834 Enrollment ID: I20150710000943 |
| Provider Name | Elizabeth M Murrill |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1104114362 PECOS PAC ID: 4486967791 Enrollment ID: I20150715002101 |
| Provider Name | Mark A Bradford |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1295907707 PECOS PAC ID: 1052581584 Enrollment ID: I20150722006464 |
| Provider Name | John C Stenberg |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710286992 PECOS PAC ID: 0143445767 Enrollment ID: I20150723007801 |
| Provider Name | Joshua M Johnston |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245595388 PECOS PAC ID: 7911211560 Enrollment ID: I20150728003045 |
| Provider Name | Michael R Bouska |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669727145 PECOS PAC ID: 1951615178 Enrollment ID: I20150731016950 |
| Provider Name | Sarah N Hellmann |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1144514829 PECOS PAC ID: 1557675295 Enrollment ID: I20150807015418 |
| Provider Name | Marika Y Gassner |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1730345331 PECOS PAC ID: 0042442303 Enrollment ID: I20150825005925 |
| Provider Name | Kacie Talcott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154707669 PECOS PAC ID: 8325354426 Enrollment ID: I20150903002889 |
| Provider Name | Sarah E Serrano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730447350 PECOS PAC ID: 3678702685 Enrollment ID: I20150921001347 |
| Provider Name | Natalia Usatii |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1255618955 PECOS PAC ID: 5395053227 Enrollment ID: I20150925002580 |
| Provider Name | Jamie A Hopewell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427386838 PECOS PAC ID: 6608918685 Enrollment ID: I20151001002811 |
| Provider Name | Mark W Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942564281 PECOS PAC ID: 0840444295 Enrollment ID: I20151009000527 |
| Provider Name | Brenda K Rantala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396112017 PECOS PAC ID: 7719297753 Enrollment ID: I20151104000466 |
| Provider Name | Sarah A Carver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750751871 PECOS PAC ID: 8729398136 Enrollment ID: I20151113001099 |
| Provider Name | Elizabeth J Gualandi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962720649 PECOS PAC ID: 4284890658 Enrollment ID: I20151217000488 |
| Provider Name | Roza S Pacifico |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104144427 PECOS PAC ID: 2860688447 Enrollment ID: I20160105001392 |
| Provider Name | Adelaida M Miro |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1861437709 PECOS PAC ID: 1254321672 Enrollment ID: I20160127002691 |
| Provider Name | Taylor Marilyn Johnston |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831536762 PECOS PAC ID: 4587963889 Enrollment ID: I20160506001746 |
| Provider Name | Nicholas S Boehling |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1013208149 PECOS PAC ID: 9436448784 Enrollment ID: I20160510001816 |
| Provider Name | Mckenzie E Dean |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427498005 PECOS PAC ID: 6507155124 Enrollment ID: I20160525000615 |
| Provider Name | Ellen B Meyers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417063843 PECOS PAC ID: 4789871450 Enrollment ID: I20160608000455 |
| Provider Name | Emily Berry |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1275707606 PECOS PAC ID: 3072687532 Enrollment ID: I20160621002812 |
| Provider Name | Michael M Woll |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1104857770 PECOS PAC ID: 7618132614 Enrollment ID: I20160704000000 |
| Provider Name | Brian H Mott |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1811126782 PECOS PAC ID: 4284889114 Enrollment ID: I20160711001153 |
| Provider Name | Jon B Roberts |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1568696235 PECOS PAC ID: 3375839426 Enrollment ID: I20160915001921 |
| Provider Name | Anthony D Gunsul |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366780066 PECOS PAC ID: 7911294509 Enrollment ID: I20160926001260 |
| Provider Name | Celeste I Nelson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1114109238 PECOS PAC ID: 5294999785 Enrollment ID: I20160927002435 |
| Provider Name | Anh Thi Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124461462 PECOS PAC ID: 7012141468 Enrollment ID: I20161021002125 |
| Provider Name | Debora Leonardo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033661327 PECOS PAC ID: 4183906217 Enrollment ID: I20170124002928 |
| Provider Name | Linda D Becker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194098756 PECOS PAC ID: 6103088489 Enrollment ID: I20170201002546 |
| Provider Name | Richard D Reed |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1174508857 PECOS PAC ID: 8123191681 Enrollment ID: I20170324001609 |
| Provider Name | Mathias L Stoenescu |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1245232776 PECOS PAC ID: 0749214450 Enrollment ID: I20170503001914 |
| Provider Name | Kathryn M Shine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720522873 PECOS PAC ID: 1759662505 Enrollment ID: I20170510000753 |
| Provider Name | Caroline Jayne Cook |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932545753 PECOS PAC ID: 2769610401 Enrollment ID: I20170629001502 |
| Provider Name | Michael T Wahl |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1710253893 PECOS PAC ID: 5395038061 Enrollment ID: I20170705000592 |
| Provider Name | Andrew J Riggle |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1093008617 PECOS PAC ID: 8527352475 Enrollment ID: I20170801001516 |
| Provider Name | Jennifer Dixon |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1659509446 PECOS PAC ID: 4486962297 Enrollment ID: I20170802003528 |
| Provider Name | Leslie Mccalister |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316365992 PECOS PAC ID: 3072732502 Enrollment ID: I20170823002887 |
| Provider Name | Tony Adams |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1497098602 PECOS PAC ID: 5799926291 Enrollment ID: I20170928003126 |
| Provider Name | Christina T Echternach |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1831604578 PECOS PAC ID: 1254691736 Enrollment ID: I20180131002309 |
| Provider Name | Phuong H Nguyen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1285782987 PECOS PAC ID: 9234375510 Enrollment ID: I20180227001832 |
| Provider Name | Kaitlin Enker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841703576 PECOS PAC ID: 6608137088 Enrollment ID: I20180227001980 |
| Provider Name | Chrisotpher M Schuler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285713735 PECOS PAC ID: 2567352057 Enrollment ID: I20180409001370 |
| Provider Name | Todd W Clover |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1164532107 PECOS PAC ID: 9931122058 Enrollment ID: I20180524002924 |
| Provider Name | Christopher D Brubaker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306226451 PECOS PAC ID: 8325350747 Enrollment ID: I20180726000923 |
| Provider Name | Alwin Borgmann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073920880 PECOS PAC ID: 6204126188 Enrollment ID: I20180829004388 |
| Provider Name | Audrey Jacquette Eden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609247972 PECOS PAC ID: 9436454840 Enrollment ID: I20180904003259 |
| Provider Name | David Steiger |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1013114487 PECOS PAC ID: 1951566025 Enrollment ID: I20180912000066 |
| Provider Name | Mary E Condron |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1841580503 PECOS PAC ID: 9931346913 Enrollment ID: I20181023002622 |
| Provider Name | Margaret Ellen Lukens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508025065 PECOS PAC ID: 1254684749 Enrollment ID: I20181031000490 |
| Provider Name | Lauren E Habel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427542935 PECOS PAC ID: 8426392440 Enrollment ID: I20181203001472 |
| Provider Name | Maryclare S Sarff |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1104029768 PECOS PAC ID: 1951590454 Enrollment ID: I20181205001564 |
| Provider Name | Jodi Janell Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851866859 PECOS PAC ID: 5698013944 Enrollment ID: I20190211003171 |
| Provider Name | Jaclyn E Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013419530 PECOS PAC ID: 3678813748 Enrollment ID: I20190327002837 |
| Provider Name | Andrea L Purtzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447702428 PECOS PAC ID: 6204116866 Enrollment ID: I20190401002237 |
| Provider Name | Christina Fitzmaurice |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1790915528 PECOS PAC ID: 6103141031 Enrollment ID: I20190515001241 |
| Provider Name | Nicholas I Buss |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1346414752 PECOS PAC ID: 0840468963 Enrollment ID: I20190520002588 |
| Provider Name | Ryan Keith Nelson |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1851633143 PECOS PAC ID: 8921305137 Enrollment ID: I20190805001776 |
| Provider Name | Nicole Marie Berrigan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1750778858 PECOS PAC ID: 6901110048 Enrollment ID: I20190829003511 |
| Provider Name | Juan A Tamariz Loor |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1225286586 PECOS PAC ID: 3274750492 Enrollment ID: I20190905003585 |
| Provider Name | Timothy Michael Baumgarte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114584331 PECOS PAC ID: 0244569648 Enrollment ID: I20190910003786 |
| Provider Name | Hannah Webster Ferrie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316509474 PECOS PAC ID: 8921337197 Enrollment ID: I20190912003404 |
| Provider Name | Kelly Nadine Bolling-ringler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639531171 PECOS PAC ID: 5890073621 Enrollment ID: I20191030002743 |
| Provider Name | Emily Rose Ziegler |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1225417330 PECOS PAC ID: 6305141573 Enrollment ID: I20191101001437 |
| Provider Name | Andrea Michelle Keller |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1629236146 PECOS PAC ID: 6800044223 Enrollment ID: I20191101002355 |
| Provider Name | Christopher R Guiley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730547688 PECOS PAC ID: 8729360037 Enrollment ID: I20191119000447 |
| Provider Name | Merrie Katelyn Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659923225 PECOS PAC ID: 4385077791 Enrollment ID: I20191125002404 |
| Provider Name | Kathleen Ann Wachtler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912269168 PECOS PAC ID: 1759528466 Enrollment ID: I20200108001666 |
| Provider Name | Michael Earl Westley |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1992854178 PECOS PAC ID: 6204887128 Enrollment ID: I20200115001257 |
| Provider Name | Tarris Webber |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154771780 PECOS PAC ID: 5193018307 Enrollment ID: I20200127001385 |
| Provider Name | Trisha D Alderson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1144552936 PECOS PAC ID: 6305974817 Enrollment ID: I20200205000500 |
| Provider Name | Joshua M Gulvin |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1821408444 PECOS PAC ID: 4688893167 Enrollment ID: I20200814001488 |
| Provider Name | Laurie E Doyon |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326400151 PECOS PAC ID: 9032403597 Enrollment ID: I20200819001509 |
| Provider Name | Anne C Onishi |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1134462302 PECOS PAC ID: 2567709942 Enrollment ID: I20200820000899 |
| Provider Name | Molly L Garbus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235579194 PECOS PAC ID: 6800101932 Enrollment ID: I20200903002393 |
| Provider Name | Michael H.a. Sultan |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1538505326 PECOS PAC ID: 3577837921 Enrollment ID: I20200908000550 |
| Provider Name | Samuel J Garbus |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1639519440 PECOS PAC ID: 0840503033 Enrollment ID: I20200910000871 |
| Provider Name | Eric A Ford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407210610 PECOS PAC ID: 8426477738 Enrollment ID: I20201005002674 |
| Provider Name | Cynthia L Maree |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1225063506 PECOS PAC ID: 0941228704 Enrollment ID: I20201019000891 |
| Provider Name | Lisa D Herzig |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1790910701 PECOS PAC ID: 3173847027 Enrollment ID: I20201104002450 |
| Provider Name | Patrick R Waber |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1225059439 PECOS PAC ID: 7517007388 Enrollment ID: I20201119002456 |
| Provider Name | Nicole Lee Utt |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1881122695 PECOS PAC ID: 4789095290 Enrollment ID: I20201203002996 |
| Provider Name | Eden Fair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730796525 PECOS PAC ID: 6103239835 Enrollment ID: I20210119001278 |
| Provider Name | Jaclyn M Gamboa |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1225649205 PECOS PAC ID: 7810302338 Enrollment ID: I20210216001009 |
| Provider Name | Marielle Virginia Mckean |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1326592098 PECOS PAC ID: 8921413055 Enrollment ID: I20210223000380 |
| Provider Name | Bryden Thomas Considine |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1356760839 PECOS PAC ID: 2668791716 Enrollment ID: I20210609003019 |
| Provider Name | Robert S Yee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497743116 PECOS PAC ID: 2062487176 Enrollment ID: I20210624003847 |
| Provider Name | Emma Considine |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1447695226 PECOS PAC ID: 9537489372 Enrollment ID: I20210626000027 |
| Provider Name | David Michael Mehr |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144726092 PECOS PAC ID: 1456601632 Enrollment ID: I20210627000021 |
| Provider Name | Jonathan Lowy |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1619926300 PECOS PAC ID: 6406957794 Enrollment ID: I20210812000399 |
| Provider Name | Jessica L Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356918767 PECOS PAC ID: 8921402843 Enrollment ID: I20210813001640 |
| Provider Name | Olivia O Boots |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1992280747 PECOS PAC ID: 3971909342 Enrollment ID: I20210909003346 |
| Provider Name | Casey Scott Law |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346252152 PECOS PAC ID: 1052474129 Enrollment ID: I20210928003565 |
| Provider Name | Kiley A Hewett |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1265966022 PECOS PAC ID: 6002163987 Enrollment ID: I20210928003667 |
| Provider Name | Sophia R Larson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1295113108 PECOS PAC ID: 6305146150 Enrollment ID: I20211013001516 |
| Provider Name | Inger J Lied |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467942227 PECOS PAC ID: 4284982521 Enrollment ID: I20211026003600 |
| Provider Name | Suzanne Kristen Puryear |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215607890 PECOS PAC ID: 0345639522 Enrollment ID: I20211109001464 |
| Provider Name | Ian Alexander Smith |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1588770655 PECOS PAC ID: 8820041197 Enrollment ID: I20211109002838 |
| Provider Name | Julia Fanning Delbeccaro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518587070 PECOS PAC ID: 4385033265 Enrollment ID: I20211115002091 |
| Provider Name | Alyssa Lynn Dukes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730752437 PECOS PAC ID: 1153710850 Enrollment ID: I20211118002089 |
| Provider Name | Leonard D Savage |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376584011 PECOS PAC ID: 5496786006 Enrollment ID: I20220217001938 |
| Provider Name | Miranda Melton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730444001 PECOS PAC ID: 8426200114 Enrollment ID: I20220325001930 |
| Provider Name | Maria Graciela Stanley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750042008 PECOS PAC ID: 2961899265 Enrollment ID: I20220504001836 |
| Provider Name | Rachel Evon Elzinga |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1053958116 PECOS PAC ID: 5193112415 Enrollment ID: I20220504002638 |
| Provider Name | Andrew Kersh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841941226 PECOS PAC ID: 9234518721 Enrollment ID: I20220613002299 |
| Provider Name | Benjamin Barsotti |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1003947649 PECOS PAC ID: 5092869636 Enrollment ID: I20220617002495 |
| Provider Name | Lisa Kristine Mizeur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003455742 PECOS PAC ID: 8628406873 Enrollment ID: I20220714000834 |
| Provider Name | Whitney Sumner |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1639602113 PECOS PAC ID: 0143601419 Enrollment ID: I20220718002110 |
| Provider Name | Curtis Bergquist |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1093140014 PECOS PAC ID: 7113218926 Enrollment ID: I20220725001431 |
| Provider Name | Erinn Hughes |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1114260635 PECOS PAC ID: 9335441617 Enrollment ID: I20220815001649 |
| Provider Name | Andrew B Shaffer |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1104359561 PECOS PAC ID: 2668759879 Enrollment ID: I20220823001950 |
| Provider Name | Laura Selby |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1902290877 PECOS PAC ID: 6800166471 Enrollment ID: I20220831001089 |
| Provider Name | Lindsey K Goddard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265024145 PECOS PAC ID: 2567877707 Enrollment ID: I20220901003615 |
| Provider Name | Michal Alice Montana |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1831695352 PECOS PAC ID: 9537544226 Enrollment ID: I20220915003832 |
| Provider Name | Caitlyn Truong |
|---|---|
| Provider Type | Practitioner - Surgical Oncology |
| Provider Identifiers | NPI Number: 1225216088 PECOS PAC ID: 4183758626 Enrollment ID: I20221018001679 |
| Provider Name | Amy Yuan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1447512041 PECOS PAC ID: 7517246465 Enrollment ID: I20221027003082 |
| Provider Name | Frankie Ann Mauti |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1225243397 PECOS PAC ID: 3577930189 Enrollment ID: I20221110000277 |
| Provider Name | Ineke M. Ojanen |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1396043709 PECOS PAC ID: 1759759251 Enrollment ID: I20221114002832 |
| Provider Name | Kid Jonathan Cabrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588386676 PECOS PAC ID: 4385012715 Enrollment ID: I20221116001232 |
| Provider Name | Ariel Monteau |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1710607148 PECOS PAC ID: 9931579935 Enrollment ID: I20230109002544 |
| Provider Name | Michelle C Czopek |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1548922164 PECOS PAC ID: 9335510114 Enrollment ID: I20230116000395 |
| Provider Name | Richard Lesperance |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1194927228 PECOS PAC ID: 4284881459 Enrollment ID: I20230216001583 |
| Provider Name | Breanna Davis |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1649828286 PECOS PAC ID: 1254798713 Enrollment ID: I20230530000516 |
| Provider Name | Mia Leah Neeb |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1083824189 PECOS PAC ID: 0042677056 Enrollment ID: I20230607000788 |
| Provider Name | Karen Christine Gregory |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366156218 PECOS PAC ID: 0244690410 Enrollment ID: I20230719002710 |
| Provider Name | Jeremy Kenison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386087534 PECOS PAC ID: 4688895055 Enrollment ID: I20230829003776 |
| Provider Name | Randy J. Kjorstad |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1043283336 PECOS PAC ID: 6002003639 Enrollment ID: I20230906003016 |
| Provider Name | Lynette Marshall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083971147 PECOS PAC ID: 9335396878 Enrollment ID: I20230906003301 |
| Provider Name | Amanda Underwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528756848 PECOS PAC ID: 3173979853 Enrollment ID: I20231101001820 |
| Provider Name | Nicholas Schneider |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740733815 PECOS PAC ID: 7315399367 Enrollment ID: I20240116001825 |
Pine Springs Health Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 711 Ne Irving Ave, Bend, OR 97701 Phone: 541-480-2827 | |
Mosaic Medical Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2577 Ne Courtney Dr Ste 100, Bend, OR 97701 Phone: 541-383-3005 | |
Adam Derr, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 528 Ne Greenwood Ave, Bend, OR 97701 Phone: 541-385-7890 Fax: 541-388-2606 | |
Driven Enterprises Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 20700 Wandalea Dr, Bend, OR 97701 Phone: 435-669-2930 | |
Bend Plastic Surgery Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1239 Ne Medical Center Dr Ste 240, Bend, OR 97701 Phone: 541-749-2282 Fax: 541-749-2283 | |
St. Charles Immediate Care Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2600 Ne Neff Rd, Bend, OR 97701 Phone: 541-706-3700 Fax: 541-706-3730 |