| 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 |
| Certification 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 | () | 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 | 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 | Christina M Ford |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528057593 PECOS PAC ID: 0547169971 Enrollment ID: I20040107000435 |
| Provider Name | Douglas Chester Gruzd |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043246069 PECOS PAC ID: 6507759768 Enrollment ID: I20040203000665 |
| Provider Name | Jeffrey T Caba |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1255319711 PECOS PAC ID: 4981595238 Enrollment ID: I20040324000687 |
| Provider Name | James R Verheyden |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1013912591 PECOS PAC ID: 8022900935 Enrollment ID: I20040326000025 |
| Provider Name | Darin J Clement |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1053477331 PECOS PAC ID: 3173415650 Enrollment ID: I20040329000766 |
| 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 | Timothy a Hill |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1891790382 PECOS PAC ID: 3173510393 Enrollment ID: I20040429000367 |
| Provider Name | Richard H Bochner |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1881621290 PECOS PAC ID: 3971590043 Enrollment ID: I20040429000799 |
| Provider Name | Raymond Tien |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1073518551 PECOS PAC ID: 8224026828 Enrollment ID: I20040503001499 |
| Provider Name | Anthony C Hinz |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1336146208 PECOS PAC ID: 8022088830 Enrollment ID: I20040729000165 |
| Provider Name | Timothy S Bollom |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1639179930 PECOS PAC ID: 9739071994 Enrollment ID: I20040803001497 |
| Provider Name | Glenn M Wulf |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1144226754 PECOS PAC ID: 1658342688 Enrollment ID: I20040804000030 |
| Provider Name | Omar R Garza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467569731 PECOS PAC ID: 2961473780 Enrollment ID: I20040804001507 |
| Provider Name | Suzanne E Browning-tarbet |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1306808142 PECOS PAC ID: 4385616713 Enrollment ID: I20040806001045 |
| 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 | Jason K Winebarger |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1376660597 PECOS PAC ID: 3971571787 Enrollment ID: I20040921000327 |
| Provider Name | Kent D Yundt |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1275518797 PECOS PAC ID: 2961461405 Enrollment ID: I20041008000879 |
| 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 | Amy L Howard |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1548244049 PECOS PAC ID: 7719936657 Enrollment ID: I20050118000422 |
| Provider Name | Cassandra Gail Dixon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1760453641 PECOS PAC ID: 7810940988 Enrollment ID: I20050301000477 |
| 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 | Matthew Rode |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477559383 PECOS PAC ID: 4789627134 Enrollment ID: I20050607000112 |
| Provider Name | James a Hall |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1285636290 PECOS PAC ID: 4880630185 Enrollment ID: I20050707000780 |
| Provider Name | Blair D Halperin |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1447258710 PECOS PAC ID: 5991732786 Enrollment ID: I20050723000039 |
| 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 | Timothy Krigbaum |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831149079 PECOS PAC ID: 2466477872 Enrollment ID: I20051013000823 |
| Provider Name | Aaron E Askew |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1366428401 PECOS PAC ID: 6305875220 Enrollment ID: I20051115000765 |
| Provider Name | Michael C Dennis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1538145677 PECOS PAC ID: 0941229363 Enrollment ID: I20051115000815 |
| Provider Name | Brett I Gingold |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1124090634 PECOS PAC ID: 2163413071 Enrollment ID: I20051115000984 |
| 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 | Sandra Holloway |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902898729 PECOS PAC ID: 9436055852 Enrollment ID: I20060321000098 |
| Provider Name | Casey a Osborne Rodhouse |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619067378 PECOS PAC ID: 4284645227 Enrollment ID: I20060505000406 |
| Provider Name | Manish Mehta |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1750310173 PECOS PAC ID: 8921002593 Enrollment ID: I20060913000261 |
| Provider Name | Jonathan Schultz |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1740385863 PECOS PAC ID: 0244261469 Enrollment ID: I20061017000003 |
| Provider Name | Korena L Larsen-farris |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1275597247 PECOS PAC ID: 6406829514 Enrollment ID: I20061102000404 |
| Provider Name | Anthony G Hadden |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1396701504 PECOS PAC ID: 1355340951 Enrollment ID: I20061208000289 |
| Provider Name | Eric S Dildine |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194897264 PECOS PAC ID: 1254331788 Enrollment ID: I20070108000324 |
| Provider Name | Joe Thomas Mccook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154344869 PECOS PAC ID: 3072518422 Enrollment ID: I20070227000330 |
| Provider Name | Tianna L Welch |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1376689059 PECOS PAC ID: 7911000369 Enrollment ID: I20070306000108 |
| 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 | Thomas J Dernbach |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962465211 PECOS PAC ID: 2062510829 Enrollment ID: I20070604000015 |
| Provider Name | Carl E Miller |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1982760260 PECOS PAC ID: 1153429501 Enrollment ID: I20070607000532 |
| 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 | Soma I Lilly |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1659302552 PECOS PAC ID: 1456383587 Enrollment ID: I20070829000325 |
| Provider Name | Kyle J Shaver |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639241763 PECOS PAC ID: 4284739996 Enrollment ID: I20070924000703 |
| 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 | Johanna R Peterson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1396934238 PECOS PAC ID: 1951481092 Enrollment ID: I20080102000463 |
| 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 | Steven R King |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1992715924 PECOS PAC ID: 6002986759 Enrollment ID: I20080606000197 |
| 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 | Darlene Elizabeth Nastansky |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1447352232 PECOS PAC ID: 9638243389 Enrollment ID: I20080730000200 |
| Provider Name | Frances E Biagioli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083621916 PECOS PAC ID: 8022186790 Enrollment ID: I20081008000128 |
| 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 | Dean T Nakadate |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1609972439 PECOS PAC ID: 1850454778 Enrollment ID: I20090120000268 |
| Provider Name | Cody a Byrnes |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1609012152 PECOS PAC ID: 2567525496 Enrollment ID: I20090120000291 |
| Provider Name | Deanna Elaine Cully |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1912967779 PECOS PAC ID: 6901812338 Enrollment ID: I20090126000745 |
| Provider Name | Stephanie R Scott |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1033111521 PECOS PAC ID: 2769561513 Enrollment ID: I20090213000038 |
| Provider Name | Natasha M Tiffany |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1972697167 PECOS PAC ID: 8224127428 Enrollment ID: I20090216000056 |
| Provider Name | Erin P Butler |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1528077930 PECOS PAC ID: 2163429275 Enrollment ID: I20090527000486 |
| Provider Name | Ryan J Petersen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568551521 PECOS PAC ID: 0749342251 Enrollment ID: I20090910000368 |
| Provider Name | Adam J Short |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1417103268 PECOS PAC ID: 4082751631 Enrollment ID: I20091030000137 |
| Provider Name | Bradley E Scott |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1497085922 PECOS PAC ID: 5193867752 Enrollment ID: I20100120000076 |
| Provider Name | Matthew S Cook |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1568630135 PECOS PAC ID: 4789728197 Enrollment ID: I20100224000073 |
| Provider Name | Nathan R Thompson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124287321 PECOS PAC ID: 8022182658 Enrollment ID: I20100630000843 |
| Provider Name | Sean a Suttle |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1740287457 PECOS PAC ID: 3678465366 Enrollment ID: I20100703000048 |
| Provider Name | Scott R Jacobson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1730184201 PECOS PAC ID: 0345153433 Enrollment ID: I20100719000186 |
| Provider Name | Gary Lachenmyer |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1821095928 PECOS PAC ID: 7012049653 Enrollment ID: I20100719000227 |
| Provider Name | William J Corrigan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1124078738 PECOS PAC ID: 1850424649 Enrollment ID: I20100730000301 |
| Provider Name | Pamela J Irby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295773901 PECOS PAC ID: 4385639137 Enrollment ID: I20100802000222 |
| Provider Name | Bruce L Hill |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1689671265 PECOS PAC ID: 1254465404 Enrollment ID: I20100810000919 |
| Provider Name | James O Nelson |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1104826205 PECOS PAC ID: 4082798350 Enrollment ID: I20101012000613 |
| Provider Name | Amy V Asher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013153865 PECOS PAC ID: 9830382068 Enrollment ID: I20101020001269 |
| Provider Name | Brant D Wommack |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023164613 PECOS PAC ID: 7911050877 Enrollment ID: I20101025001081 |
| Provider Name | Gennadiy Bakis |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1184614455 PECOS PAC ID: 0749221042 Enrollment ID: I20101104001447 |
| Provider Name | Deborah a Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720082795 PECOS PAC ID: 2062606809 Enrollment ID: I20101105000076 |
| Provider Name | Andrew Asher |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871766774 PECOS PAC ID: 5890869705 Enrollment ID: I20101108001107 |
| 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 | Shannon K Brasher |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1255547287 PECOS PAC ID: 2668379918 Enrollment ID: I20101209000693 |
| Provider Name | Jennifer H Mccleery |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1215247994 PECOS PAC ID: 1153518311 Enrollment ID: I20101214000640 |
| Provider Name | Sara T Stafford |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1780824334 PECOS PAC ID: 1153510292 Enrollment ID: I20110105000905 |
| Provider Name | Brandon W Brasher |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629284641 PECOS PAC ID: 7618166307 Enrollment ID: I20110111000946 |
| Provider Name | Damon Christopher Stout |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629210612 PECOS PAC ID: 3072792035 Enrollment ID: I20110121000899 |
| Provider Name | Erin E Finter |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1245462894 PECOS PAC ID: 9830223353 Enrollment ID: I20110816000446 |
| Provider Name | Neil D Lancefield |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134392962 PECOS PAC ID: 9638348121 Enrollment ID: I20110818000465 |
| Provider Name | Nicole C Mcleod |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1992005920 PECOS PAC ID: 9436320132 Enrollment ID: I20110928000455 |
| 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 | Stacie M Fulcher |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1013193556 PECOS PAC ID: 8426120528 Enrollment ID: I20111022000082 |
| Provider Name | Mary Cathleen Farnsworth |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1154600724 PECOS PAC ID: 0042483703 Enrollment ID: I20111026000097 |
| Provider Name | Karl J Schultheiss |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1265478325 PECOS PAC ID: 5799819157 Enrollment ID: I20111123000652 |
| Provider Name | Meghan G Brecke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245490606 PECOS PAC ID: 2668647652 Enrollment ID: I20111201000724 |
| Provider Name | Beth a Orton |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235456427 PECOS PAC ID: 5193991149 Enrollment ID: I20111222000326 |
| Provider Name | Jeffrey R Mathisen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1740200484 PECOS PAC ID: 7416992508 Enrollment ID: I20120110000835 |
| Provider Name | Lauren K Beebe |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578880894 PECOS PAC ID: 6406023399 Enrollment ID: I20120117000750 |
| 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 | Diklah Orevi |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1568720563 PECOS PAC ID: 2466616685 Enrollment ID: I20120619000328 |
| 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 | Daniel Oliver Pederson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811130669 PECOS PAC ID: 2961659198 Enrollment ID: I20120823000410 |
| Provider Name | Matthew P Clausen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164664553 PECOS PAC ID: 6709035934 Enrollment ID: I20121004000092 |
| Provider Name | Kevin L Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992021505 PECOS PAC ID: 4688824857 Enrollment ID: I20121024000378 |
| Provider Name | Erin E Schneider |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982864724 PECOS PAC ID: 4587842182 Enrollment ID: I20121207000148 |
| Provider Name | Monica R Giamellaro |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1487855763 PECOS PAC ID: 8628160009 Enrollment ID: I20121211000306 |
| Provider Name | Angelina Maria 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 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 | Keri S Mcpherson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336572874 PECOS PAC ID: 0345484325 Enrollment ID: I20130912000346 |
| 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 | Sherolyn J Jennart |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1649323742 PECOS PAC ID: 3870491764 Enrollment ID: I20140226001598 |
| Provider Name | Kelsey Rose Peterson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1902144983 PECOS PAC ID: 3577708718 Enrollment ID: I20140410001279 |
| Provider Name | Jennifer K 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 | Tamara L Houston |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1497172761 PECOS PAC ID: 5799900205 Enrollment ID: I20140625001186 |
| Provider Name | Matthew T Snodgrass |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932469335 PECOS PAC ID: 7810138195 Enrollment ID: I20140716000860 |
| Provider Name | Maureen F Mccaffrey |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1871925933 PECOS PAC ID: 8527286111 Enrollment ID: I20140822001548 |
| Provider Name | Neil E Roundy |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1174723720 PECOS PAC ID: 1355596156 Enrollment ID: I20140923002425 |
| Provider Name | Tracy L Kennelley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1639507288 PECOS PAC ID: 3274762869 Enrollment ID: I20141016000694 |
| Provider Name | Drury H Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285954511 PECOS PAC ID: 5294868923 Enrollment ID: I20141027000604 |
| Provider Name | Erin Margaret Nelli |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1487869129 PECOS PAC ID: 1951471242 Enrollment ID: I20141029000009 |
| Provider Name | Kristopher M Cox |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1871936880 PECOS PAC ID: 2062633357 Enrollment ID: I20141030001473 |
| Provider Name | Christopher L Wright |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1912314352 PECOS PAC ID: 0042432650 Enrollment ID: I20141117000063 |
| Provider Name | Katrina Marie Cypcar |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1285030023 PECOS PAC ID: 7214259357 Enrollment ID: I20141201001147 |
| Provider Name | Allen Rafael |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1962408526 PECOS PAC ID: 0648351825 Enrollment ID: I20141215002545 |
| Provider Name | John R Orth |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1255768412 PECOS PAC ID: 3375866825 Enrollment ID: I20150108001167 |
| 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 | Jessica H Fredeen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1720261530 PECOS PAC ID: 1052481553 Enrollment ID: I20150112002199 |
| 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 | Thomas Gadsby Asturias |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336334135 PECOS PAC ID: 3173613031 Enrollment ID: I20150130002231 |
| Provider Name | Angela C Tye |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1942541164 PECOS PAC ID: 6608192174 Enrollment ID: I20150226001898 |
| Provider Name | Torree M Mcgowan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1689713794 PECOS PAC ID: 4082896725 Enrollment ID: I20150605002403 |
| 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 | Andrew Fletcher Parker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306005053 PECOS PAC ID: 0446413462 Enrollment ID: I20150622000575 |
| Provider Name | Ian C. Riddock |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1669582870 PECOS PAC ID: 1759544356 Enrollment ID: I20150710000336 |
| 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 | 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 | Erin E Legrand |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1699009217 PECOS PAC ID: 2163619560 Enrollment ID: I20150728003396 |
| Provider Name | Sarah Elizabeth Brown |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1699001800 PECOS PAC ID: 4587978010 Enrollment ID: I20150728005984 |
| Provider Name | Anthony J Fillmore |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1982680518 PECOS PAC ID: 5496777252 Enrollment ID: I20150729006626 |
| Provider Name | David Allen Brown |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1730269341 PECOS PAC ID: 0648448654 Enrollment ID: I20150731016761 |
| 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 | Mathew Paluck |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1154633121 PECOS PAC ID: 8628383213 Enrollment ID: I20150811004808 |
| Provider Name | Marika Y Gassner |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1730345331 PECOS PAC ID: 0042442303 Enrollment ID: I20150825005925 |
| Provider Name | Andrew Kleaveland |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043571342 PECOS PAC ID: 2365676079 Enrollment ID: I20150903001749 |
| Provider Name | Kacie Talcott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154707669 PECOS PAC ID: 8325354426 Enrollment ID: I20150903002889 |
| Provider Name | Katherine Rajotte |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1568872737 PECOS PAC ID: 8426365503 Enrollment ID: I20150922002860 |
| Provider Name | Natalia Usatii |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1255618955 PECOS PAC ID: 5395053227 Enrollment ID: I20150925002580 |
| Provider Name | Mark W Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942564281 PECOS PAC ID: 0840444295 Enrollment ID: I20151009000527 |
| Provider Name | Heather Ahlf |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1700296837 PECOS PAC ID: 0244549913 Enrollment ID: I20151020001004 |
| Provider Name | Alyssa Leigh Argabright |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1326418104 PECOS PAC ID: 4789993320 Enrollment ID: I20151021001101 |
| 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 | Noelle D Vacchio-caulley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1265806053 PECOS PAC ID: 5294036455 Enrollment ID: I20151214001587 |
| 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 | Amanda L Fair |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619262060 PECOS PAC ID: 8628206299 Enrollment ID: I20160526000307 |
| 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 | Richard C Ombrembowski |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235541376 PECOS PAC ID: 6709196272 Enrollment ID: I20160726002531 |
| Provider Name | Bessie Joy Perkey |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1386873040 PECOS PAC ID: 5890933055 Enrollment ID: I20160815001292 |
| Provider Name | Amy J Cameron |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386843498 PECOS PAC ID: 8729173653 Enrollment ID: I20160823003053 |
| 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 | John P Tully |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1992964563 PECOS PAC ID: 4981753472 Enrollment ID: I20160927000377 |
| Provider Name | Celeste I Nelson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1114109238 PECOS PAC ID: 5294999785 Enrollment ID: I20160927002435 |
| Provider Name | James R Muntz |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083009088 PECOS PAC ID: 9931487279 Enrollment ID: I20161020001990 |
| Provider Name | Anh Thi Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124461462 PECOS PAC ID: 7012141468 Enrollment ID: I20161021002125 |
| Provider Name | Joshua Ryan Burns |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1760847057 PECOS PAC ID: 2365720968 Enrollment ID: I20161102002285 |
| Provider Name | Kara L Davis Faith |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1063726271 PECOS PAC ID: 7113108218 Enrollment ID: I20161220001576 |
| Provider Name | Bryce D Campbell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932591963 PECOS PAC ID: 7416267448 Enrollment ID: I20161222000602 |
| 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 | Angela Marie Rehder |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1265971386 PECOS PAC ID: 7618253543 Enrollment ID: I20170407001444 |
| Provider Name | Kenneth a Conklin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1669851606 PECOS PAC ID: 0547546202 Enrollment ID: I20170411002084 |
| Provider Name | Kathryn M Shine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720522873 PECOS PAC ID: 1759662505 Enrollment ID: I20170510000753 |
| Provider Name | Catherine Heaphy |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1609281518 PECOS PAC ID: 8224259569 Enrollment ID: I20170517001054 |
| Provider Name | Collette M Rhyner |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1447707948 PECOS PAC ID: 6709153059 Enrollment ID: I20170517001639 |
| Provider Name | Priscilla Pang |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1346565710 PECOS PAC ID: 3971758780 Enrollment ID: I20170524002667 |
| Provider Name | Lori Mcpherson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1598895385 PECOS PAC ID: 7214032754 Enrollment ID: I20170616000931 |
| Provider Name | Mark Curry |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942610373 PECOS PAC ID: 8729356639 Enrollment ID: I20170619001139 |
| Provider Name | Son T DO |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1285668822 PECOS PAC ID: 2668371337 Enrollment ID: I20170626001871 |
| 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 | Meagan M Herda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811315419 PECOS PAC ID: 9032336664 Enrollment ID: I20170803001656 |
| Provider Name | Matthew R Lilley |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1003166612 PECOS PAC ID: 7315219946 Enrollment ID: I20170816004556 |
| 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 | Kelly a Fair |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1144547415 PECOS PAC ID: 3173768918 Enrollment ID: I20171107002265 |
| Provider Name | Nathaniel Charles Schwab |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1750892261 PECOS PAC ID: 4486912763 Enrollment ID: I20171214000160 |
| 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 | Ekaterina Y Urch |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1548550890 PECOS PAC ID: 6709178072 Enrollment ID: I20180208001836 |
| 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 | Kellene a Fisler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760982474 PECOS PAC ID: 2365704368 Enrollment ID: I20180402000739 |
| Provider Name | Chrisotpher M Schuler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285713735 PECOS PAC ID: 2567352057 Enrollment ID: I20180409001370 |
| Provider Name | David Berg Kirkpatrick |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003138256 PECOS PAC ID: 0042340556 Enrollment ID: I20180410003186 |
| Provider Name | Meghan Elizabeth Gilroy |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1821388083 PECOS PAC ID: 1951526292 Enrollment ID: I20180517001228 |
| Provider Name | Daniel Mark Weiland |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1679650436 PECOS PAC ID: 3072642396 Enrollment ID: I20180524001256 |
| 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 | Terry Shih |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1629206818 PECOS PAC ID: 5991012478 Enrollment ID: I20180820003701 |
| 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 | Megan M Lindley Bauer |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1912475948 PECOS PAC ID: 9133467277 Enrollment ID: I20190214002091 |
| Provider Name | Elke Jacobsen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1730544552 PECOS PAC ID: 6608167309 Enrollment ID: I20190222001938 |
| Provider Name | Christine Joy Goodall |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1053869685 PECOS PAC ID: 9537448964 Enrollment ID: I20190308002540 |
| Provider Name | Amanda K Bryson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1952850448 PECOS PAC ID: 5991045643 Enrollment ID: I20190318000508 |
| 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 | Emma a Frost-briley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1952845166 PECOS PAC ID: 2567746001 Enrollment ID: I20190409000833 |
| 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 | Meredith Anne Helfrich |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1720547060 PECOS PAC ID: 8325381817 Enrollment ID: I20190524001560 |
| Provider Name | Sarah C. Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477749836 PECOS PAC ID: 5294820718 Enrollment ID: I20190530002658 |
| Provider Name | Brock Thomas Rutherford |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1841640430 PECOS PAC ID: 5991084642 Enrollment ID: I20190613000798 |
| Provider Name | Christopher William Healy |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1356784847 PECOS PAC ID: 0143562090 Enrollment ID: I20190718001801 |
| Provider Name | Nathan Joseph Ansbaugh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497140313 PECOS PAC ID: 3971802505 Enrollment ID: I20190802002215 |
| Provider Name | Katherine Wurlitzer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1538553573 PECOS PAC ID: 6002171709 Enrollment ID: I20190802002363 |
| 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 | Brian M Carter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235581257 PECOS PAC ID: 0941595201 Enrollment ID: I20190808001808 |
| Provider Name | Joshua D. Fitzmaurice |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962690552 PECOS PAC ID: 3274610738 Enrollment ID: I20190826001063 |
| Provider Name | Courtney Walker |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1154684504 PECOS PAC ID: 1557686094 Enrollment ID: I20190827001520 |
| 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 | Andrea Michelle Keller |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1629236146 PECOS PAC ID: 6800044223 Enrollment ID: I20191101002355 |
| Provider Name | Tamarind Marie Keating |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508012568 PECOS PAC ID: 5799851192 Enrollment ID: I20191105000263 |
| 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 | Craig Ferguson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477717130 PECOS PAC ID: 8729155080 Enrollment ID: I20191216001905 |
| Provider Name | Kathleen Ann Wachtler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912269168 PECOS PAC ID: 1759528466 Enrollment ID: I20200108001666 |
| Provider Name | Sally Ann Roberts |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1851884837 PECOS PAC ID: 3375978067 Enrollment ID: I20200128001011 |
| Provider Name | Robert William Dolan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1508400979 PECOS PAC ID: 1153757869 Enrollment ID: I20200128002146 |
| Provider Name | Marrett R Hild |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1437614997 PECOS PAC ID: 4981938206 Enrollment ID: I20200128002628 |
| Provider Name | Stephanie Henderson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861968810 PECOS PAC ID: 3476988502 Enrollment ID: I20200131002279 |
| 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 | Mindy C Lipsitz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043606148 PECOS PAC ID: 3971801721 Enrollment ID: I20200330001607 |
| Provider Name | Karly Nesbitt |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1649835208 PECOS PAC ID: 5890024798 Enrollment ID: I20200518002613 |
| Provider Name | Cody R Manriquez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194357897 PECOS PAC ID: 0446671283 Enrollment ID: I20200602001991 |
| Provider Name | Dayna M Dobson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1023669645 PECOS PAC ID: 9032532833 Enrollment ID: I20200702002472 |
| Provider Name | Megan J Wolf |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194068957 PECOS PAC ID: 5890090559 Enrollment ID: I20200715001013 |
| Provider Name | Clayton Stanford Garthe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023541174 PECOS PAC ID: 0042551574 Enrollment ID: I20200716003587 |
| Provider Name | Alan Jennings Griffin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780118844 PECOS PAC ID: 0941579171 Enrollment ID: I20200806002975 |
| 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 | Paul Albert Shultz |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1295148757 PECOS PAC ID: 5092018754 Enrollment ID: I20200824001855 |
| 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 | Sierra E Lowrimore |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235619933 PECOS PAC ID: 4880948363 Enrollment ID: I20201209001742 |
| Provider Name | Nicole C Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568822864 PECOS PAC ID: 5496045338 Enrollment ID: I20201215001691 |
| Provider Name | Eden Fair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730796525 PECOS PAC ID: 6103239835 Enrollment ID: I20210119001278 |
| Provider Name | Joshua M Scott |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1376099184 PECOS PAC ID: 9436437407 Enrollment ID: I20210201002544 |
| Provider Name | Kyle a Gray |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1811477359 PECOS PAC ID: 5799195061 Enrollment ID: I20210219001417 |
| Provider Name | Daniel Bao Doan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235438730 PECOS PAC ID: 3072738772 Enrollment ID: I20210325001313 |
| Provider Name | Susanne Denise Demeester |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316980196 PECOS PAC ID: 2961409420 Enrollment ID: I20210401001882 |
| Provider Name | Marie Elise Mency |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932567880 PECOS PAC ID: 0648511832 Enrollment ID: I20210428001053 |
| Provider Name | Taylor Jay Higlin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194310052 PECOS PAC ID: 6901215458 Enrollment ID: I20210512003293 |
| Provider Name | Cassie Palensky |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1992225775 PECOS PAC ID: 9133528078 Enrollment ID: I20210526002792 |
| Provider Name | Bryden Thomas Considine |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1356760839 PECOS PAC ID: 2668791716 Enrollment ID: I20210609003019 |
| Provider Name | Rebecca Ann Sultan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1891243713 PECOS PAC ID: 0941577209 Enrollment ID: I20210609003225 |
| Provider Name | Kees a Negaard |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700381373 PECOS PAC ID: 3274879861 Enrollment ID: I20210610002958 |
| 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 | Kristi B Sterry |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1265018402 PECOS PAC ID: 7416359237 Enrollment ID: I20210715001562 |
| Provider Name | Noah Harwood |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932557212 PECOS PAC ID: 7315295706 Enrollment ID: I20210716001824 |
| Provider Name | Connor a King |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1750761003 PECOS PAC ID: 6204138068 Enrollment ID: I20210804002080 |
| Provider Name | Jessica L Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356918767 PECOS PAC ID: 8921402843 Enrollment ID: I20210813001640 |
| Provider Name | Adam Paul Lane |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1760874184 PECOS PAC ID: 5799082350 Enrollment ID: I20210827003070 |
| 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 | Suzanne H Hiramatsu |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023310919 PECOS PAC ID: 1658594296 Enrollment ID: I20210910001721 |
| Provider Name | Caroline Mari Baghdikian-nauser |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790281640 PECOS PAC ID: 9133525231 Enrollment ID: I20210914002771 |
| Provider Name | Benjamin a Walsh |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1558982587 PECOS PAC ID: 7618374414 Enrollment ID: I20210921003058 |
| Provider Name | Hanna Marie Tyner |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1518599596 PECOS PAC ID: 7719309475 Enrollment ID: I20210924001637 |
| Provider Name | Devon Charlotte Riley |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1104329739 PECOS PAC ID: 4981950086 Enrollment ID: I20210924002973 |
| 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 Hewett |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1265966022 PECOS PAC ID: 6002163987 Enrollment ID: I20210928003667 |
| Provider Name | Jake Brandt |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083211734 PECOS PAC ID: 3072911924 Enrollment ID: I20211007002187 |
| 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 | Rachel N Kosek |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1043807894 PECOS PAC ID: 0648668863 Enrollment ID: I20211020002553 |
| Provider Name | Inger J Lied |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467942227 PECOS PAC ID: 4284982521 Enrollment ID: I20211026003600 |
| Provider Name | Joshua Malcolm Rust |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962094573 PECOS PAC ID: 8022406891 Enrollment ID: I20211027002378 |
| Provider Name | Erin Hanlon Genereux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043899875 PECOS PAC ID: 5294124509 Enrollment ID: I20211108000892 |
| 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 | Andrew James Henderson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1164043972 PECOS PAC ID: 7214327881 Enrollment ID: I20211214002163 |
| Provider Name | Jonathan Bradley Munns |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1164875373 PECOS PAC ID: 4284912494 Enrollment ID: I20211221002924 |
| Provider Name | Hyung Chil Kang |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1992709471 PECOS PAC ID: 5294724514 Enrollment ID: I20211228002134 |
| Provider Name | Kayla Anne Carlson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1841811619 PECOS PAC ID: 4688065576 Enrollment ID: I20220104001102 |
| Provider Name | Christopher Patrick Kaufman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1558939116 PECOS PAC ID: 8123410552 Enrollment ID: I20220117000252 |
| Provider Name | Leonard D Savage |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376584011 PECOS PAC ID: 5496786006 Enrollment ID: I20220217001938 |
| Provider Name | Aleah Driscoll |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1417555251 PECOS PAC ID: 4284048794 Enrollment ID: I20220302002888 |
| Provider Name | Eric Svendsen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962982165 PECOS PAC ID: 4284066531 Enrollment ID: I20220323001302 |
| Provider Name | Miranda Rowsey |
|---|---|
| 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 | Erin K Donovan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205399318 PECOS PAC ID: 8729410170 Enrollment ID: I20220531000525 |
| Provider Name | Luke Welle |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679013445 PECOS PAC ID: 6709134703 Enrollment ID: I20220610000396 |
| Provider Name | Andrew Kersh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841941226 PECOS PAC ID: 9234518721 Enrollment ID: I20220613002299 |
| Provider Name | Alexander Ochman |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1316392970 PECOS PAC ID: 8628362894 Enrollment ID: I20220616002878 |
| Provider Name | Benjamin B Barsotti |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1003947649 PECOS PAC ID: 5092869636 Enrollment ID: I20220617002495 |
| Provider Name | Lindsey Pruyn |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1699755512 PECOS PAC ID: 0042239451 Enrollment ID: I20220624000288 |
| Provider Name | Russell Shepherd Lewis |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1104273382 PECOS PAC ID: 1355635038 Enrollment ID: I20220707002198 |
| 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 | Sarah Catherine O'brien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801415138 PECOS PAC ID: 8628450483 Enrollment ID: I20220727000907 |
| Provider Name | Erinn Hughes |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1114260635 PECOS PAC ID: 9335441617 Enrollment ID: I20220815001649 |
| Provider Name | Katie Marie Lahusen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336601483 PECOS PAC ID: 7517392319 Enrollment ID: I20220818002919 |
| Provider Name | Victoria Winter Anderson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1316682958 PECOS PAC ID: 6305229675 Enrollment ID: I20220818003217 |
| 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 | Kimia Ighani Newell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1942841176 PECOS PAC ID: 4486081098 Enrollment ID: I20220831001896 |
| 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 | Madeline Veronica-justus Regge |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083237119 PECOS PAC ID: 5597141598 Enrollment ID: I20220928002396 |
| Provider Name | Adam Lindsay |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1811371669 PECOS PAC ID: 1850656919 Enrollment ID: I20221010002755 |
| Provider Name | Caitlyn Truong |
|---|---|
| Provider Type | Practitioner - Surgical Oncology |
| Provider Identifiers | NPI Number: 1225216088 PECOS PAC ID: 4183758626 Enrollment ID: I20221018001679 |
| Provider Name | Sarah L Kent |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356683254 PECOS PAC ID: 7214250083 Enrollment ID: I20221024001058 |
| Provider Name | Chelsea Mcdowell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1538782966 PECOS PAC ID: 4486071347 Enrollment ID: I20221025000980 |
| 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 | Ian Mcalister |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1740613637 PECOS PAC ID: 2062647589 Enrollment ID: I20221202002280 |
| Provider Name | Alicia Stearns |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1144853169 PECOS PAC ID: 0749619864 Enrollment ID: I20221205003033 |
| Provider Name | Patrick Fink |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194258954 PECOS PAC ID: 5092148080 Enrollment ID: I20221219002624 |
| 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 | Gina Peach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023734605 PECOS PAC ID: 5395116172 Enrollment ID: I20230116000552 |
| Provider Name | Evelina V Kravchuk |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962117853 PECOS PAC ID: 8921472986 Enrollment ID: I20230315001107 |
| Provider Name | James Hughes |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1992366959 PECOS PAC ID: 7911239454 Enrollment ID: I20230407001580 |
| 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 | Kevin Ferguson Prince |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1447757943 PECOS PAC ID: 1759630684 Enrollment ID: I20230605001402 |
| 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 | Mitchell Davis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1023721883 PECOS PAC ID: 6507223237 Enrollment ID: I20230612000470 |
| Provider Name | Rodney L Camp |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1972568228 PECOS PAC ID: 5698787943 Enrollment ID: I20230612002136 |
| Provider Name | Farris N Serio |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1619466232 PECOS PAC ID: 6103284393 Enrollment ID: I20230620003240 |
| Provider Name | Grant M Branam |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1982097705 PECOS PAC ID: 6901287580 Enrollment ID: I20230706003521 |
| 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 | Carolyn L Luppens |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1669868030 PECOS PAC ID: 6204116676 Enrollment ID: I20230901001306 |
| 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 | Alexandria Danielle Calande |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1952083453 PECOS PAC ID: 2668827841 Enrollment ID: I20231007000354 |
| Provider Name | Amanda Underwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528756848 PECOS PAC ID: 3173979853 Enrollment ID: I20231101001820 |
| Provider Name | Kevin Dombey |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184273708 PECOS PAC ID: 8325479363 Enrollment ID: I20231129002884 |
| Provider Name | Jennifer Lynn Dunaj |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1669140588 PECOS PAC ID: 3173971298 Enrollment ID: I20231130001870 |
| Provider Name | Rebekka Anne Thorud |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528594199 PECOS PAC ID: 0648694828 Enrollment ID: I20231205002135 |
| Provider Name | Kendra Mifflin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245811769 PECOS PAC ID: 0840608402 Enrollment ID: I20231229002451 |
| Provider Name | Matthew Wilhelm |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1093263105 PECOS PAC ID: 7315281482 Enrollment ID: I20240103000404 |
| Provider Name | Lori a Mehrl-kilian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275568875 PECOS PAC ID: 3476553330 Enrollment ID: I20240110000532 |
| Provider Name | Madison Alexandra Odiorne |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578345773 PECOS PAC ID: 9436500881 Enrollment ID: I20240110000891 |
| Provider Name | Catherine Elizabeth Fairgrieve Appel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013256569 PECOS PAC ID: 1355755562 Enrollment ID: I20240110001886 |
| Provider Name | Nicholas Schneider |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740733815 PECOS PAC ID: 7315399367 Enrollment ID: I20240116001825 |
| Provider Name | Micaela Marie Scafani |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194504803 PECOS PAC ID: 4486007788 Enrollment ID: I20240201003540 |
| Provider Name | Bailey Ann Mcdonald |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1457129322 PECOS PAC ID: 7214371764 Enrollment ID: I20240329002226 |
| Provider Name | Wesley Williams |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730685579 PECOS PAC ID: 1557794351 Enrollment ID: I20240329002664 |
| Provider Name | Joshua Jaramillo |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1952763047 PECOS PAC ID: 8022302868 Enrollment ID: I20240401001361 |
| Provider Name | Regan William Polk |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1407546294 PECOS PAC ID: 6204274533 Enrollment ID: I20240405002127 |
| Provider Name | Jennifer L Dolan |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1558505446 PECOS PAC ID: 0143668384 Enrollment ID: I20240405002782 |
| Provider Name | William Martin Brueggemann |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285716217 PECOS PAC ID: 6709862725 Enrollment ID: I20240408001846 |
| Provider Name | Victor Duong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548654296 PECOS PAC ID: 1254756109 Enrollment ID: I20240409003089 |
| Provider Name | Shaan Akhtar |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1790165876 PECOS PAC ID: 4880908961 Enrollment ID: I20240424001780 |
| Provider Name | Trisha Wilder |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1609154517 PECOS PAC ID: 2264666031 Enrollment ID: I20240428000102 |
| Provider Name | Hanxiang Alex Wang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245736982 PECOS PAC ID: 8022366194 Enrollment ID: I20240604004321 |
| Provider Name | Devon Noelle Varner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306628755 PECOS PAC ID: 9335681303 Enrollment ID: I20240605001981 |
| Provider Name | Jason L Koerner |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1356846232 PECOS PAC ID: 2961766365 Enrollment ID: I20240614001395 |
| Provider Name | Joshua a Sprague |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831712280 PECOS PAC ID: 9830583152 Enrollment ID: I20240624001526 |
| Provider Name | Alex J Lancaster |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1376047977 PECOS PAC ID: 9537592399 Enrollment ID: I20240626004156 |
| Provider Name | Stephen Daniel Krivan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1164934865 PECOS PAC ID: 3971863234 Enrollment ID: I20240702004380 |
| Provider Name | Emily Halpert |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1134628068 PECOS PAC ID: 7618238940 Enrollment ID: I20240702004557 |
| Provider Name | Emily Sauck |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1942838164 PECOS PAC ID: 7618399478 Enrollment ID: I20240720000517 |
| Provider Name | Julia Singh |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1922857010 PECOS PAC ID: 0244776144 Enrollment ID: I20240727000687 |
| Provider Name | Jessica Frenkel |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881452373 PECOS PAC ID: 4486192895 Enrollment ID: I20240816001171 |
| Provider Name | Lauren Michelle Andring |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1326507484 PECOS PAC ID: 3375081367 Enrollment ID: I20240821004521 |
| Provider Name | Neil Donal Okelly |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1902330475 PECOS PAC ID: 1557605219 Enrollment ID: I20240822000822 |
| Provider Name | Emily Maxwell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1134647241 PECOS PAC ID: 3870869282 Enrollment ID: I20240827004606 |
| Provider Name | Natalie Halapin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881049310 PECOS PAC ID: 4082909627 Enrollment ID: I20240901000082 |
| Provider Name | Nicholas R Faunce |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1598287567 PECOS PAC ID: 1254799695 Enrollment ID: I20240916000380 |
| Provider Name | Julianna Curtis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407574288 PECOS PAC ID: 4688059017 Enrollment ID: I20241001000815 |
| Provider Name | Emma Moreland |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1326720178 PECOS PAC ID: 2466983267 Enrollment ID: I20241003003423 |
| Provider Name | Margaret Virginia Pennington |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1194221713 PECOS PAC ID: 2365798139 Enrollment ID: I20241003003845 |
| Provider Name | Hunter P Heck |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1205556164 PECOS PAC ID: 4981136876 Enrollment ID: I20241016003996 |
| Provider Name | Hannah M Rondeau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215775879 PECOS PAC ID: 3971035668 Enrollment ID: I20241018003562 |
| Provider Name | Amida Hair |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1588217905 PECOS PAC ID: 2567884521 Enrollment ID: I20241112001880 |
| Provider Name | Carli D. Corpus |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1639880388 PECOS PAC ID: 0648704403 Enrollment ID: I20241115001660 |
| Provider Name | Bonnie Wickham |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1225058902 PECOS PAC ID: 0345246690 Enrollment ID: I20241119000290 |
| Provider Name | Morgen Phillips |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1871182626 PECOS PAC ID: 8325454499 Enrollment ID: I20241119004944 |
| Provider Name | Gail Pearson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164551214 PECOS PAC ID: 6002862257 Enrollment ID: I20250103000396 |
| Provider Name | Sarah E Schoenhals |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1992202766 PECOS PAC ID: 1052744950 Enrollment ID: I20250103001823 |
| Provider Name | Michelle P Wolf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841921277 PECOS PAC ID: 7719367390 Enrollment ID: I20250108004132 |
| Provider Name | Nathan Anthony Rasor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1750101143 PECOS PAC ID: 0345778916 Enrollment ID: I20250109002676 |
| Provider Name | Joanne Michelle Gomez-arnold |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1558741363 PECOS PAC ID: 4082904032 Enrollment ID: I20250213000679 |
| Provider Name | Kylee Madison Adamek |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1326720186 PECOS PAC ID: 7810417656 Enrollment ID: I20250224000949 |
| Provider Name | Erik J Olson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1174844815 PECOS PAC ID: 2961771274 Enrollment ID: I20250303001866 |
| Provider Name | James C Fleming |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1912401761 PECOS PAC ID: 1850640277 Enrollment ID: I20250407003522 |
| Provider Name | Ashton Dodson-lupton |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1689240954 PECOS PAC ID: 1658768247 Enrollment ID: I20250416001361 |
| Provider Name | Alyssa Van Heerden |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1487050746 PECOS PAC ID: 2567786395 Enrollment ID: I20250527001731 |
| Provider Name | Riley Jo Seidel |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1104646496 PECOS PAC ID: 9032628409 Enrollment ID: I20250605001870 |
| Provider Name | Kate Moya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952733677 PECOS PAC ID: 0446494868 Enrollment ID: I20250617001844 |
| Provider Name | Sophia Tam |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1225425085 PECOS PAC ID: 9830436096 Enrollment ID: I20250618002535 |
| Provider Name | Mackenzie Margaret Bartz |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1225619141 PECOS PAC ID: 8921478801 Enrollment ID: I20250702001795 |
| Provider Name | Benjamin Foreman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1154769891 PECOS PAC ID: 6800191834 Enrollment ID: I20250708002533 |
| Provider Name | Kathleen Schwegler |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1912308479 PECOS PAC ID: 4082939657 Enrollment ID: I20250715001049 |
| Provider Name | Kelley Meredith |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194255646 PECOS PAC ID: 1850657537 Enrollment ID: I20250801003230 |
| Provider Name | Matthew T Essman |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1407268402 PECOS PAC ID: 4385086057 Enrollment ID: I20250808002466 |
| Provider Name | Shana Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124190590 PECOS PAC ID: 3476548892 Enrollment ID: I20250813000754 |
| Provider Name | Melissa Medina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639587439 PECOS PAC ID: 8527386028 Enrollment ID: I20250813001882 |
| Provider Name | Jared Hilton |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1396308961 PECOS PAC ID: 8921426404 Enrollment ID: I20250814001047 |
| Provider Name | Marissa Leonore Bruno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073262986 PECOS PAC ID: 3476937459 Enrollment ID: I20250814002860 |
| Provider Name | Mimi Amanda Harzan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1477175446 PECOS PAC ID: 4385035955 Enrollment ID: I20250814004841 |
| Provider Name | Leah Lieber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770223794 PECOS PAC ID: 1557741592 Enrollment ID: I20250814004853 |
| Provider Name | Carolyn Gaulke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912388752 PECOS PAC ID: 9133435621 Enrollment ID: I20250820001554 |
| Provider Name | Christopher Lewis |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1932533015 PECOS PAC ID: 1052658200 Enrollment ID: I20250828003814 |
| Provider Name | Bryon Anderson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861297764 PECOS PAC ID: 1759883481 Enrollment ID: I20250903002962 |
| Provider Name | Jaired Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760260855 PECOS PAC ID: 8224530019 Enrollment ID: I20250909002984 |
| Provider Name | Mary Rouzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134632334 PECOS PAC ID: 5991064438 Enrollment ID: I20250929001518 |
| Provider Name | Kari Ella Smerud |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1982599890 PECOS PAC ID: 6901303452 Enrollment ID: I20251009002233 |
| Provider Name | Julianna Ruotolo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386419745 PECOS PAC ID: 0042707606 Enrollment ID: I20251016001949 |
| Provider Name | Clay Triplehorn |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1447227152 PECOS PAC ID: 9335151802 Enrollment ID: I20251021003734 |
| Provider Name | Aaron King |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1538454426 PECOS PAC ID: 7214230606 Enrollment ID: I20251028001411 |
| Provider Name | Niloofar Farmani |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1205087079 PECOS PAC ID: 0446302590 Enrollment ID: I20251111000845 |
| Provider Name | Elyssa Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528776531 PECOS PAC ID: 7517330236 Enrollment ID: I20251121001112 |
| Provider Name | Kelly E Wingerter |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1073957072 PECOS PAC ID: 7719291566 Enrollment ID: I20251121003979 |
| Provider Name | Lucas K Vitzthum |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1487049938 PECOS PAC ID: 2961824412 Enrollment ID: I20251126003795 |
| Provider Name | Khang Nguyen |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1518385004 PECOS PAC ID: 0547504953 Enrollment ID: I20251202000579 |
| Provider Name | Jeanine Root |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447674049 PECOS PAC ID: 6406079284 Enrollment ID: I20251204002394 |
| Provider Name | Karen Axten |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1295199404 PECOS PAC ID: 2567757172 Enrollment ID: I20251209001972 |
| Provider Name | Justin Badal |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1548641202 PECOS PAC ID: 3577972017 Enrollment ID: I20251209002378 |
| Provider Name | Colleen Frances Openshaw |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1437991809 PECOS PAC ID: 2567956337 Enrollment ID: I20251209003650 |
| Provider Name | Joshua a Tesulov |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619710514 PECOS PAC ID: 8527552892 Enrollment ID: I20251214000094 |
| Provider Name | Justin Scott Fuller |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1609767227 PECOS PAC ID: 3971097114 Enrollment ID: I20251215001856 |
| Provider Name | Brittany N Wagner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285082693 PECOS PAC ID: 4587952528 Enrollment ID: I20260107004423 |
| Provider Name | Katherine Wyrick |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1609309376 PECOS PAC ID: 2163815739 Enrollment ID: I20260129002546 |
| Provider Name | Christopher Mcgann |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1477640423 PECOS PAC ID: 1557252285 Enrollment ID: I20260220001977 |
| Provider Name | Madison Hooper |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1467295162 PECOS PAC ID: 1557843372 Enrollment ID: I20260302002950 |
| Provider Name | Nicole Lex |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114893609 PECOS PAC ID: 8224511415 Enrollment ID: I20260316003322 |
| Provider Name | Nicholas Jon Spoerke |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1942401583 PECOS PAC ID: 0446416010 Enrollment ID: I20260317003008 |
| Provider Name | Donald W Furman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1154881779 PECOS PAC ID: 5890023931 Enrollment ID: I20260327003062 |
| Provider Name | Seneca Lawson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1154204337 PECOS PAC ID: 5799250635 Enrollment ID: I20260408003662 |
| Provider Name | Luke Martin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659637502 PECOS PAC ID: 5395977995 Enrollment ID: I20260417001225 |
| Provider Name | Lindsey Bischoff |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1609422328 PECOS PAC ID: 1951724905 Enrollment ID: I20260424000793 |
| Provider Name | Sandra Bernklau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790821882 PECOS PAC ID: 1658556329 Enrollment ID: I20260429001760 |
| Provider Name | Nicole Deboer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861191702 PECOS PAC ID: 1355798372 Enrollment ID: I20260505002924 |
| Provider Name | Erik Peltz |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1669528287 PECOS PAC ID: 1759535297 Enrollment ID: I20260625002178 |
Pine Springs Health LLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 711 Ne Irving Ave, Bend, OR 97701 Phone: 541-330-9110 |
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 |
Domani Medical LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 685 Se 3rd St, Bend, OR 97702 Phone: 541-516-4099 |
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 |
Nexphase Telehealth, LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 221 Nw Outlook Vista Dr, Bend, OR 97703 Phone: 330-635-7750 |