| St Lukes Clinic - Magic Valley/jerome | |
|
775 Pole Line Rd W Twin Falls ID 83301-5814 | |
| (208) 814-1000 | |
| Not Available |
| Full Name | St Lukes Clinic - Magic Valley/jerome |
|---|---|
| Speciality | Family Medicine |
| Location | 775 Pole Line Rd W, Twin Falls, Idaho |
| Authorized Official Name and Position | Kathryn Fowler (SENIOR VP, CFO) |
| Authorized Official Contact | 2083818717 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Lukes Clinic - Magic Valley/jerome Po Box 640 Boise ID 83701-0640 Ph: (208) 706-5000 | St Lukes Clinic - Magic Valley/jerome 775 Pole Line Rd W Twin Falls ID 83301-5814 Ph: (208) 814-1000 |
| NPI Number | 1790718229 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 04/23/2026 |
| Certification Date | 04/23/2026 |
| Medicare PECOS PAC ID | 1052217478 |
|---|---|
| Medicare Enrollment ID | O20031208000899 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790718229 | NPI | - | NPPES |
| DA1879 | Other | ID | RR MEDICARE |
| 1257846 | Other | ID | MEDICARE - CLINIC |
| 133992 | Other | ID | MEDICARE - RHC |
| 806593000 | Medicaid | ID |
| Provider Name | John a Baker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124061262 PECOS PAC ID: 6901702166 Enrollment ID: I20031209000507 |
| Provider Name | John L Etcheto |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1073547113 PECOS PAC ID: 9436050788 Enrollment ID: I20040119000603 |
| Provider Name | Johnny M Urrutia |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831290097 PECOS PAC ID: 0941113278 Enrollment ID: I20040218001039 |
| Provider Name | Kari L Brose |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356308282 PECOS PAC ID: 6507752003 Enrollment ID: I20040223000842 |
| Provider Name | Gail R Cook |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1447217955 PECOS PAC ID: 9234027061 Enrollment ID: I20040304001003 |
| Provider Name | Richard J Hammond |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558306589 PECOS PAC ID: 7113819756 Enrollment ID: I20040327000260 |
| Provider Name | Brian W Fortuin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740221191 PECOS PAC ID: 5496647034 Enrollment ID: I20040331000674 |
| Provider Name | Jared P Walker |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1558490698 PECOS PAC ID: 4082692660 Enrollment ID: I20040709001190 |
| Provider Name | Randal L Wraalstad |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1255334066 PECOS PAC ID: 0244218469 Enrollment ID: I20040713000512 |
| Provider Name | Duane Rick Hansen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417995374 PECOS PAC ID: 6709844467 Enrollment ID: I20050103000209 |
| Provider Name | Joseph L Waters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578503926 PECOS PAC ID: 5496704868 Enrollment ID: I20050113000114 |
| Provider Name | Heather M Kohring |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285742452 PECOS PAC ID: 2062463292 Enrollment ID: I20050204000659 |
| Provider Name | Darren W Coleman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1568479301 PECOS PAC ID: 1456390673 Enrollment ID: I20050427000993 |
| Provider Name | Matthew E Williamson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467428540 PECOS PAC ID: 5395785935 Enrollment ID: I20050503001161 |
| Provider Name | Brian L Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336138783 PECOS PAC ID: 1557301892 Enrollment ID: I20050505001228 |
| Provider Name | Elizabeth H Sugden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356485767 PECOS PAC ID: 4284670795 Enrollment ID: I20050706001097 |
| Provider Name | Michael J Cannon |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1033131495 PECOS PAC ID: 4486659307 Enrollment ID: I20060928000266 |
| Provider Name | Eric S Cassidy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982647830 PECOS PAC ID: 4880699594 Enrollment ID: I20060930000009 |
| Provider Name | Elva M Mcnurlin |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1295772549 PECOS PAC ID: 4981602976 Enrollment ID: I20061130000205 |
| Provider Name | Dennis M Enomoto |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1649226127 PECOS PAC ID: 7416968656 Enrollment ID: I20061214000541 |
| Provider Name | Seth N Wheeler |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1548222516 PECOS PAC ID: 5193708980 Enrollment ID: I20070319000311 |
| Provider Name | Blake B Jensen |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1316060890 PECOS PAC ID: 2769582584 Enrollment ID: I20070710000215 |
| Provider Name | Lance G Hubsmith |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1013037522 PECOS PAC ID: 8820198641 Enrollment ID: I20070710000237 |
| Provider Name | John D Steffens |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1871683409 PECOS PAC ID: 0941262455 Enrollment ID: I20070827000556 |
| Provider Name | Jennifer L Preucil |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922042209 PECOS PAC ID: 2769575026 Enrollment ID: I20070904000210 |
| Provider Name | Kathryn G Reese |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1386688802 PECOS PAC ID: 6002909363 Enrollment ID: I20070904000232 |
| Provider Name | Gregory P Jones |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568406692 PECOS PAC ID: 4789777947 Enrollment ID: I20070904000278 |
| Provider Name | Darin K Powell |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1255454732 PECOS PAC ID: 3476646480 Enrollment ID: I20070907000242 |
| Provider Name | Daniel G Preucil |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215971593 PECOS PAC ID: 0749373611 Enrollment ID: I20070908000031 |
| Provider Name | Patricia a Billings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235173493 PECOS PAC ID: 8729171608 Enrollment ID: I20070908000178 |
| Provider Name | Cameron T Clark |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1407049422 PECOS PAC ID: 8224122577 Enrollment ID: I20070918000551 |
| Provider Name | Mitchell J Moffitt |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093895229 PECOS PAC ID: 2466548268 Enrollment ID: I20071009000851 |
| Provider Name | Richard a Sandison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649216961 PECOS PAC ID: 5092802934 Enrollment ID: I20071024000660 |
| Provider Name | Nicholas J Perius |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1154363000 PECOS PAC ID: 9931288214 Enrollment ID: I20080512000623 |
| Provider Name | Lucie a Dimaggio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336188267 PECOS PAC ID: 3577646199 Enrollment ID: I20080702000617 |
| Provider Name | Blake Pedersen |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1790994283 PECOS PAC ID: 0547334146 Enrollment ID: I20080730000661 |
| Provider Name | Robert T Lewis |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1326200734 PECOS PAC ID: 8628142668 Enrollment ID: I20080808000354 |
| Provider Name | Joshua E Hall |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477675726 PECOS PAC ID: 5698869915 Enrollment ID: I20080811000451 |
| Provider Name | Russell Holliday |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598884900 PECOS PAC ID: 6507871845 Enrollment ID: I20080822000544 |
| Provider Name | Joshua W Kern |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366486003 PECOS PAC ID: 2062588791 Enrollment ID: I20080904000215 |
| Provider Name | Brent L Norris |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1497902274 PECOS PAC ID: 6709954969 Enrollment ID: I20081001000666 |
| Provider Name | Heather Shaw |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1962445817 PECOS PAC ID: 1355419268 Enrollment ID: I20081006000251 |
| Provider Name | Jeffrey L Mulert |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1790988509 PECOS PAC ID: 3375601446 Enrollment ID: I20081017000346 |
| Provider Name | Ryan C Melvin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679519276 PECOS PAC ID: 6800954934 Enrollment ID: I20081018000193 |
| Provider Name | Steven a Kohtz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093830598 PECOS PAC ID: 2163512559 Enrollment ID: I20081018000198 |
| Provider Name | Brian a Johns |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1003876137 PECOS PAC ID: 9032279328 Enrollment ID: I20081117000336 |
| Provider Name | Melissa D Merrill |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1043459696 PECOS PAC ID: 0446308019 Enrollment ID: I20090508000431 |
| Provider Name | Trevor Y Satterfield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619169299 PECOS PAC ID: 3870687023 Enrollment ID: I20090706000656 |
| Provider Name | Jonathan D Myers |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1346436367 PECOS PAC ID: 5890849269 Enrollment ID: I20090819000593 |
| Provider Name | Matthew H Packham |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578502589 PECOS PAC ID: 6204849276 Enrollment ID: I20090822000175 |
| Provider Name | Michelle L Myers |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1962533083 PECOS PAC ID: 5698749539 Enrollment ID: I20090902000481 |
| Provider Name | Trevor J Crapo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114082260 PECOS PAC ID: 7719033828 Enrollment ID: I20090915000251 |
| Provider Name | Matthew J Larsen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194916049 PECOS PAC ID: 4789742347 Enrollment ID: I20091015000589 |
| Provider Name | Daryl G Ficklin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346213303 PECOS PAC ID: 0042209702 Enrollment ID: I20091112000543 |
| Provider Name | Jared R Helms |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407035371 PECOS PAC ID: 8426146705 Enrollment ID: I20100217000397 |
| Provider Name | James S Irwin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023007465 PECOS PAC ID: 2365482965 Enrollment ID: I20100420000975 |
| Provider Name | Alice R Trabert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245229558 PECOS PAC ID: 6406984426 Enrollment ID: I20100512001094 |
| Provider Name | Timothy a Enders |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1063632495 PECOS PAC ID: 3173660289 Enrollment ID: I20100715000653 |
| Provider Name | Gregory R Ball |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1407985278 PECOS PAC ID: 8325171689 Enrollment ID: I20100806000484 |
| Provider Name | James P Westberry |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1548233570 PECOS PAC ID: 1052371960 Enrollment ID: I20110808000818 |
| Provider Name | Marc V Farnworth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124288758 PECOS PAC ID: 3476722018 Enrollment ID: I20110816000333 |
| Provider Name | Janet E Renaldi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831481233 PECOS PAC ID: 0941471221 Enrollment ID: I20110916000250 |
| Provider Name | Gregory D Walton |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1871881375 PECOS PAC ID: 2163694753 Enrollment ID: I20111003000664 |
| Provider Name | Ryan J Roberts |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093982910 PECOS PAC ID: 2466624259 Enrollment ID: I20111021000227 |
| Provider Name | Adam R Bowman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073766226 PECOS PAC ID: 1759423551 Enrollment ID: I20111114000434 |
| Provider Name | Chad R Momberger |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1356626980 PECOS PAC ID: 0345416723 Enrollment ID: I20120106000202 |
| Provider Name | Thomas C Ashby |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1962421800 PECOS PAC ID: 7517133838 Enrollment ID: I20120106000712 |
| Provider Name | John Brandon Cory |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1053682229 PECOS PAC ID: 6103086863 Enrollment ID: I20120404000674 |
| Provider Name | Eric L Bailey |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1881966885 PECOS PAC ID: 1951562370 Enrollment ID: I20120411000832 |
| Provider Name | Thomas H Zepeda |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083833933 PECOS PAC ID: 1557385820 Enrollment ID: I20120425000769 |
| Provider Name | Joseph R Frampton |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1558694570 PECOS PAC ID: 6002078920 Enrollment ID: I20120509000698 |
| Provider Name | Charles Kaiser |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1477834109 PECOS PAC ID: 1355514910 Enrollment ID: I20120612000016 |
| Provider Name | Mark a Crandall |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1619096278 PECOS PAC ID: 0840381570 Enrollment ID: I20120807000827 |
| Provider Name | Matthew W Dopp |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255575619 PECOS PAC ID: 9335395292 Enrollment ID: I20120808000403 |
| Provider Name | Jarom Frederick Lamb |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306006101 PECOS PAC ID: 5890977409 Enrollment ID: I20120810000655 |
| Provider Name | Cheryl L Beaumont |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184653016 PECOS PAC ID: 4284884396 Enrollment ID: I20121026000304 |
| Provider Name | Heather E Ellsworth |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942473335 PECOS PAC ID: 1355467341 Enrollment ID: I20121113000138 |
| Provider Name | Stanley L Greene |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1467763953 PECOS PAC ID: 2668665035 Enrollment ID: I20121126000365 |
| Provider Name | Jonathan L Hanowell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427255959 PECOS PAC ID: 2365630142 Enrollment ID: I20121126000439 |
| Provider Name | Jacob C Langston |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1922309244 PECOS PAC ID: 1759568785 Enrollment ID: I20130308000147 |
| Provider Name | John R Anderson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366490773 PECOS PAC ID: 4284879446 Enrollment ID: I20130319000093 |
| Provider Name | Susan M Marzolf |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1568447019 PECOS PAC ID: 3375596034 Enrollment ID: I20130521000141 |
| Provider Name | Bonnie L Steffens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407136823 PECOS PAC ID: 3678730140 Enrollment ID: I20130524000377 |
| Provider Name | Brendan M Petersen |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1043569056 PECOS PAC ID: 4688813959 Enrollment ID: I20130617000671 |
| Provider Name | Kurtis B Reed |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1245484096 PECOS PAC ID: 7810041852 Enrollment ID: I20130826000096 |
| Provider Name | Liang Wu |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1073776258 PECOS PAC ID: 4284766932 Enrollment ID: I20130828000009 |
| Provider Name | Nathan Allen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881908366 PECOS PAC ID: 1355585449 Enrollment ID: I20130911000085 |
| Provider Name | Bryan C Mason |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316268295 PECOS PAC ID: 3375797111 Enrollment ID: I20131028000466 |
| Provider Name | Brett J Buican |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013005446 PECOS PAC ID: 0446247084 Enrollment ID: I20131126000624 |
| Provider Name | Jerri L Bingham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063834224 PECOS PAC ID: 3779706593 Enrollment ID: I20140523001995 |
| Provider Name | Nichole S Halverson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164629887 PECOS PAC ID: 4981675600 Enrollment ID: I20140606001134 |
| Provider Name | Scott a Knight |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710917398 PECOS PAC ID: 1456577931 Enrollment ID: I20140717002403 |
| Provider Name | Michael R Mcentire |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1477875094 PECOS PAC ID: 4284827684 Enrollment ID: I20140801002362 |
| Provider Name | Brad L Hyatt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932420783 PECOS PAC ID: 0840445185 Enrollment ID: I20140905000709 |
| Provider Name | Carolyn S Doedyns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851328504 PECOS PAC ID: 8426058355 Enrollment ID: I20141006002004 |
| Provider Name | Chase a Stringam |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811286131 PECOS PAC ID: 3173745916 Enrollment ID: I20141112001133 |
| Provider Name | Amanda J Weston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609278886 PECOS PAC ID: 7315269461 Enrollment ID: I20141201001471 |
| Provider Name | Erin V Coppin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1922066042 PECOS PAC ID: 7416966064 Enrollment ID: I20150204000398 |
| Provider Name | Joshua M Hutchinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134460918 PECOS PAC ID: 4880919315 Enrollment ID: I20150204001606 |
| Provider Name | Candise a Ramsey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326313271 PECOS PAC ID: 4789904871 Enrollment ID: I20150513000012 |
| Provider Name | Chad W Hurd |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1700278553 PECOS PAC ID: 9133440043 Enrollment ID: I20150604000186 |
| Provider Name | Joseph M Strobel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013271899 PECOS PAC ID: 3274845599 Enrollment ID: I20150629003173 |
| Provider Name | Joseph C Hymas |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1942490578 PECOS PAC ID: 6406081512 Enrollment ID: I20150713002052 |
| Provider Name | Vaughn a Harris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447519160 PECOS PAC ID: 1951614494 Enrollment ID: I20150713003002 |
| Provider Name | Brad Q Starley |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1669443909 PECOS PAC ID: 9739346131 Enrollment ID: I20150729009835 |
| Provider Name | Thomas B Duff |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1326302449 PECOS PAC ID: 9436465267 Enrollment ID: I20150825003283 |
| Provider Name | Makay Oakey |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1952780090 PECOS PAC ID: 3577871979 Enrollment ID: I20151005002605 |
| Provider Name | Kelly Curtis Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548523020 PECOS PAC ID: 9436394327 Enrollment ID: I20151016001279 |
| Provider Name | Tina M Peer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346635463 PECOS PAC ID: 6002126042 Enrollment ID: I20151104000433 |
| Provider Name | Terrick E Harrild |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1285003970 PECOS PAC ID: 4981914645 Enrollment ID: I20151109001093 |
| Provider Name | James M Dunn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700108040 PECOS PAC ID: 5597991760 Enrollment ID: I20151111001301 |
| Provider Name | Jacob C Larsen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1558730291 PECOS PAC ID: 6608186119 Enrollment ID: I20151113000442 |
| Provider Name | Kathleen a Erwin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457499113 PECOS PAC ID: 1951461367 Enrollment ID: I20151223001684 |
| Provider Name | Marla J Van Tassell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801266572 PECOS PAC ID: 1355644964 Enrollment ID: I20160114001151 |
| Provider Name | David Dick |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1053649855 PECOS PAC ID: 8628107844 Enrollment ID: I20160209002751 |
| Provider Name | Kelcie J Dickerson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1992105696 PECOS PAC ID: 5890018816 Enrollment ID: I20160218000907 |
| Provider Name | Anne Fullmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891165569 PECOS PAC ID: 9739485616 Enrollment ID: I20160303001150 |
| Provider Name | William J Malone |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1568658250 PECOS PAC ID: 3779658109 Enrollment ID: I20160322002240 |
| Provider Name | John James D Angelo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124221023 PECOS PAC ID: 1052443215 Enrollment ID: I20160401001429 |
| Provider Name | Sonya S Orr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982061826 PECOS PAC ID: 0648578724 Enrollment ID: I20160406002219 |
| Provider Name | Adam M Robison |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1811335615 PECOS PAC ID: 7810207131 Enrollment ID: I20160621001965 |
| Provider Name | Catherine a Perry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952712242 PECOS PAC ID: 6204152036 Enrollment ID: I20160621002787 |
| Provider Name | Michael O Pratt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497098891 PECOS PAC ID: 4082858022 Enrollment ID: I20160629002426 |
| Provider Name | Paul K Stevens |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1376809202 PECOS PAC ID: 3375774516 Enrollment ID: I20160728001379 |
| Provider Name | Clarence J Brunson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851556229 PECOS PAC ID: 4385960210 Enrollment ID: I20160729000351 |
| Provider Name | Rafferty C Sorensen |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1609176338 PECOS PAC ID: 7719167139 Enrollment ID: I20160824000613 |
| Provider Name | Amra Suljevic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811354640 PECOS PAC ID: 1850686163 Enrollment ID: I20160825002278 |
| Provider Name | Hans T Larsen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1841678158 PECOS PAC ID: 4385930668 Enrollment ID: I20160920002163 |
| Provider Name | Jordan M Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609320126 PECOS PAC ID: 9335437987 Enrollment ID: I20161013001745 |
| Provider Name | Briana Odonnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457704249 PECOS PAC ID: 6709164999 Enrollment ID: I20161021001497 |
| Provider Name | Nichole P Horrocks |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1952690745 PECOS PAC ID: 7416125927 Enrollment ID: I20161123000599 |
| Provider Name | Ashley a Rood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881140283 PECOS PAC ID: 3476833666 Enrollment ID: I20161205001510 |
| Provider Name | Joseph a Bradbury |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073717989 PECOS PAC ID: 5496802811 Enrollment ID: I20170104000388 |
| Provider Name | Benjamin R Watson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1013466200 PECOS PAC ID: 5799066882 Enrollment ID: I20170104000520 |
| Provider Name | Sean P Mcfadden |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1073953808 PECOS PAC ID: 8628203478 Enrollment ID: I20170116000077 |
| Provider Name | Brandon D Pope |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1295105633 PECOS PAC ID: 7517249576 Enrollment ID: I20170126002474 |
| Provider Name | Murvat Usmanova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790227783 PECOS PAC ID: 3971886359 Enrollment ID: I20170208003075 |
| Provider Name | Jason Chesley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1427214543 PECOS PAC ID: 8729252598 Enrollment ID: I20170524000758 |
| Provider Name | Timothy J Ulrich |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1619263563 PECOS PAC ID: 1254587041 Enrollment ID: I20170530001588 |
| Provider Name | Stephen N Sherwood |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427375260 PECOS PAC ID: 6406080522 Enrollment ID: I20170613002282 |
| Provider Name | Corine R Faught |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285165399 PECOS PAC ID: 2668740416 Enrollment ID: I20170620000609 |
| Provider Name | Umesh C Bhandari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548572274 PECOS PAC ID: 4183944648 Enrollment ID: I20170710002816 |
| Provider Name | Paul W Dunlavy |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1598028797 PECOS PAC ID: 2264683507 Enrollment ID: I20170726000212 |
| Provider Name | Amanda J Prestigiacomo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043747579 PECOS PAC ID: 6103197355 Enrollment ID: I20170807000202 |
| Provider Name | William R Sullivan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154483477 PECOS PAC ID: 4183605884 Enrollment ID: I20170807001456 |
| Provider Name | Hailey Spevak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851826580 PECOS PAC ID: 4284905498 Enrollment ID: I20170807002261 |
| Provider Name | Sindy K Byington |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134532476 PECOS PAC ID: 0244458040 Enrollment ID: I20170814002352 |
| Provider Name | Devin S Bowman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1508113366 PECOS PAC ID: 6406007798 Enrollment ID: I20170915002221 |
| Provider Name | Casie L Spearing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780115048 PECOS PAC ID: 7810262623 Enrollment ID: I20171004002258 |
| Provider Name | Kelsie L Hendrickson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205203064 PECOS PAC ID: 8628334232 Enrollment ID: I20171115002228 |
| Provider Name | Jaclyn J Jolley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184144305 PECOS PAC ID: 3375801673 Enrollment ID: I20171214000721 |
| Provider Name | Kimberly Dolcheck Tverdy |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1073022778 PECOS PAC ID: 6507125937 Enrollment ID: I20180110003330 |
| Provider Name | Richard a Pierson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811283211 PECOS PAC ID: 8325309867 Enrollment ID: I20180226002267 |
| Provider Name | Chet R Dansie |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1003335209 PECOS PAC ID: 2264793629 Enrollment ID: I20180227000885 |
| Provider Name | Michael Garbett |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1528576089 PECOS PAC ID: 1951662931 Enrollment ID: I20180308001096 |
| Provider Name | Donna D Krapf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215444856 PECOS PAC ID: 1557626314 Enrollment ID: I20180525001334 |
| Provider Name | Todd G Hastings |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1386955060 PECOS PAC ID: 4789948308 Enrollment ID: I20180619001325 |
| Provider Name | Skyler S Shippen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194174995 PECOS PAC ID: 3173815180 Enrollment ID: I20180816000317 |
| Provider Name | Garrett a Bentley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558709121 PECOS PAC ID: 6305087693 Enrollment ID: I20180828002679 |
| Provider Name | Joel C Wagstaff |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1154702090 PECOS PAC ID: 4880986439 Enrollment ID: I20181011001463 |
| Provider Name | Alexx J Sliman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1275047409 PECOS PAC ID: 6901169531 Enrollment ID: I20181213003131 |
| Provider Name | Tamara D Schulz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881188035 PECOS PAC ID: 8628314754 Enrollment ID: I20190110003194 |
| Provider Name | Joshua Scoville |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285101097 PECOS PAC ID: 9436496890 Enrollment ID: I20190123004182 |
| Provider Name | Stephanie R Gorringe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053801456 PECOS PAC ID: 6507103967 Enrollment ID: I20190123004258 |
| Provider Name | Martha a Taylor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306871090 PECOS PAC ID: 3274629217 Enrollment ID: I20190123004385 |
| Provider Name | Jennifer J Quesnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194291823 PECOS PAC ID: 3072851765 Enrollment ID: I20190204002906 |
| Provider Name | Lauren a Schoessler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720559404 PECOS PAC ID: 0042558470 Enrollment ID: I20190211001638 |
| Provider Name | Janice L Preuit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104318690 PECOS PAC ID: 3779822572 Enrollment ID: I20190221002190 |
| Provider Name | William E Turgoose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477039261 PECOS PAC ID: 3274873716 Enrollment ID: I20190320002837 |
| Provider Name | Matthew F Silvers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467918698 PECOS PAC ID: 1456693688 Enrollment ID: I20190508001611 |
| Provider Name | Bryan L Gourley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629500947 PECOS PAC ID: 8921346727 Enrollment ID: I20190625001960 |
| Provider Name | Charles C Burtis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992060057 PECOS PAC ID: 7214164565 Enrollment ID: I20190627003138 |
| Provider Name | Kyle P Noorlander |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1023672318 PECOS PAC ID: 0143555029 Enrollment ID: I20190715002617 |
| Provider Name | John J Burk |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1407216716 PECOS PAC ID: 7214263458 Enrollment ID: I20190725003653 |
| Provider Name | Kyle G Wong |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1063897395 PECOS PAC ID: 6002142874 Enrollment ID: I20190731003598 |
| Provider Name | Brian T Olsen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487060687 PECOS PAC ID: 9335367275 Enrollment ID: I20190913001880 |
| Provider Name | Kimberly a Hartrick Buechle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699282558 PECOS PAC ID: 6002147626 Enrollment ID: I20191014001293 |
| Provider Name | Lauren a Gale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730482431 PECOS PAC ID: 4082945449 Enrollment ID: I20191016001071 |
| Provider Name | Corey V Boren |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1326378019 PECOS PAC ID: 5395871933 Enrollment ID: I20191105000780 |
| Provider Name | Sarah B. Mckee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750752648 PECOS PAC ID: 2062713324 Enrollment ID: I20191112001818 |
| Provider Name | Devin L Merritt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568859650 PECOS PAC ID: 9931533304 Enrollment ID: I20191230000934 |
| Provider Name | Matthew D Hunt |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1124497649 PECOS PAC ID: 3173826039 Enrollment ID: I20200213003053 |
| Provider Name | Corey Alan Lindberg |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790133296 PECOS PAC ID: 4183911639 Enrollment ID: I20200518001680 |
| Provider Name | Weston J Caywood |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013352814 PECOS PAC ID: 4385990738 Enrollment ID: I20200715002920 |
| Provider Name | Brandy a Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750900320 PECOS PAC ID: 6709209539 Enrollment ID: I20200716003396 |
| Provider Name | Austin I Higginson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1134635790 PECOS PAC ID: 1153685151 Enrollment ID: I20200717002395 |
| Provider Name | Robert W Tonks |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1902197866 PECOS PAC ID: 7618119322 Enrollment ID: I20200729002348 |
| Provider Name | Amanda B Gray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023528791 PECOS PAC ID: 5698191492 Enrollment ID: I20200805002141 |
| Provider Name | Andrew N Monson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366836843 PECOS PAC ID: 8224309802 Enrollment ID: I20200909001996 |
| Provider Name | Jose M Pena |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770013583 PECOS PAC ID: 7911271598 Enrollment ID: I20200914002562 |
| Provider Name | Samuel Taylor |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1073051884 PECOS PAC ID: 1254616469 Enrollment ID: I20201015001244 |
| Provider Name | Greggory S Flint |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1306238605 PECOS PAC ID: 9537438593 Enrollment ID: I20201022004242 |
| Provider Name | Andrew Lee Jones |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1386057859 PECOS PAC ID: 4486960796 Enrollment ID: I20201026002690 |
| Provider Name | Rita Woodman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639787054 PECOS PAC ID: 9739590878 Enrollment ID: I20201123000573 |
| Provider Name | Colton Jason Randall |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1174148696 PECOS PAC ID: 0446662019 Enrollment ID: I20201224000479 |
| Provider Name | Nikolai Anton Sopko |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1013283472 PECOS PAC ID: 1355599747 Enrollment ID: I20210204002229 |
| Provider Name | Lisa R Jensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528656725 PECOS PAC ID: 5193132793 Enrollment ID: I20210326001546 |
| Provider Name | Jordan Forbush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821680166 PECOS PAC ID: 5496154684 Enrollment ID: I20210519003174 |
| Provider Name | Michael G Higbee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770730939 PECOS PAC ID: 8729487244 Enrollment ID: I20210602002685 |
| Provider Name | Marshall Andersen |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1013383009 PECOS PAC ID: 2062717937 Enrollment ID: I20210616001824 |
| Provider Name | Peter J Hinckley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073907556 PECOS PAC ID: 1153638614 Enrollment ID: I20210706003046 |
| Provider Name | Creighton Lewis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376920553 PECOS PAC ID: 6305157421 Enrollment ID: I20210719001261 |
| Provider Name | Cade Call |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235634452 PECOS PAC ID: 9032512033 Enrollment ID: I20210728003298 |
| Provider Name | Peter S Shashy |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1477515971 PECOS PAC ID: 1557341856 Enrollment ID: I20210907002107 |
| Provider Name | Bethany Sappington |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1780010934 PECOS PAC ID: 3870889363 Enrollment ID: I20211101000816 |
| Provider Name | Imad Jaafar |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1821418120 PECOS PAC ID: 4385944081 Enrollment ID: I20211122001489 |
| Provider Name | Derek Mcdowell |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1083110712 PECOS PAC ID: 1759639834 Enrollment ID: I20211201002036 |
| Provider Name | Jennifer Salame |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871027094 PECOS PAC ID: 0941629943 Enrollment ID: I20211202000026 |
| Provider Name | Emina Mustafic |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861862625 PECOS PAC ID: 9931599784 Enrollment ID: I20211209001585 |
| Provider Name | Melissa a Sleight |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1821463563 PECOS PAC ID: 0648662965 Enrollment ID: I20220119001066 |
| Provider Name | Olivia Debra Cox |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1376215905 PECOS PAC ID: 4284026246 Enrollment ID: I20220125000690 |
| Provider Name | Edward Martinez |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1578983524 PECOS PAC ID: 9739304478 Enrollment ID: I20220331000584 |
| Provider Name | Kendall Turner |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1912555350 PECOS PAC ID: 3375939192 Enrollment ID: I20220404002763 |
| Provider Name | Juan Carhuas |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1508529694 PECOS PAC ID: 4284021429 Enrollment ID: I20220418002470 |
| Provider Name | Daniel Winward |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1558838136 PECOS PAC ID: 4486994340 Enrollment ID: I20220425000945 |
| Provider Name | Amanda P. Braga |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871098137 PECOS PAC ID: 7517354046 Enrollment ID: I20220429002191 |
| Provider Name | Luke Sugden |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1760972780 PECOS PAC ID: 5991053498 Enrollment ID: I20220601002032 |
| Provider Name | Brian L Stucki |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588867477 PECOS PAC ID: 8022173533 Enrollment ID: I20220613002303 |
| Provider Name | Elliot Adams |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1033597232 PECOS PAC ID: 3274849625 Enrollment ID: I20220701000506 |
| Provider Name | Jessicca Crismor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508513375 PECOS PAC ID: 6901288380 Enrollment ID: I20220802000243 |
| Provider Name | Nathan Kelsey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184943789 PECOS PAC ID: 1052640265 Enrollment ID: I20220805001400 |
| Provider Name | Katherine Elizabeth Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861146326 PECOS PAC ID: 7113309196 Enrollment ID: I20220808002250 |
| Provider Name | Emily Nicole Montague |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316683790 PECOS PAC ID: 8123401932 Enrollment ID: I20220811001488 |
| Provider Name | Logan Perkins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487218814 PECOS PAC ID: 4789911249 Enrollment ID: I20220826000281 |
| Provider Name | Justin Michael Belin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992430177 PECOS PAC ID: 7719361294 Enrollment ID: I20220901000741 |
| Provider Name | Mackenzie Gustafson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669101234 PECOS PAC ID: 1658755038 Enrollment ID: I20220902001315 |
| Provider Name | Tomas Jon Scoleri |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1265167019 PECOS PAC ID: 1456736842 Enrollment ID: I20220921002620 |
| Provider Name | Emmalee Calvert |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1124754825 PECOS PAC ID: 9335524552 Enrollment ID: I20220923000707 |
| Provider Name | Toby Christopher Rood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982101051 PECOS PAC ID: 5991180135 Enrollment ID: I20220923001573 |
| Provider Name | Abbigail Jean Sundell |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1023745056 PECOS PAC ID: 3274919899 Enrollment ID: I20221005003350 |
| Provider Name | Danielle Doucet |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1962654814 PECOS PAC ID: 6204063837 Enrollment ID: I20221018003599 |
| Provider Name | Jamie Poulsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235798356 PECOS PAC ID: 1850769035 Enrollment ID: I20221118001379 |
| Provider Name | Joshua Hansen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730542143 PECOS PAC ID: 2163717992 Enrollment ID: I20221202002846 |
| Provider Name | Shawn French |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1124238449 PECOS PAC ID: 5496984569 Enrollment ID: I20221212002401 |
| Provider Name | Megan Lynn Gully |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952023905 PECOS PAC ID: 2961872270 Enrollment ID: I20230103001213 |
| Provider Name | Mohamed Khalifa |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1528467552 PECOS PAC ID: 0446536080 Enrollment ID: I20230109000907 |
| Provider Name | Jonas Dravland |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134164502 PECOS PAC ID: 0042645244 Enrollment ID: I20230110000615 |
| Provider Name | Jessica Rose Adamson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174240139 PECOS PAC ID: 7113397928 Enrollment ID: I20230111002368 |
| Provider Name | Ismael Grachico |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1881055705 PECOS PAC ID: 7618263872 Enrollment ID: I20230120000310 |
| Provider Name | Samantha Wynn Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164141107 PECOS PAC ID: 1759752165 Enrollment ID: I20230123001960 |
| Provider Name | Austen Slade |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1467815530 PECOS PAC ID: 0941566459 Enrollment ID: I20230306002099 |
| Provider Name | William S Lefler |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1023235058 PECOS PAC ID: 8325172711 Enrollment ID: I20230313002863 |
| Provider Name | Holly a Lasure |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659649945 PECOS PAC ID: 8729452644 Enrollment ID: I20230316000405 |
| Provider Name | Robin Louise Schmidt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942912738 PECOS PAC ID: 3173997400 Enrollment ID: I20230328000534 |
| Provider Name | Jaime Ivan Delgado Caldera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710680103 PECOS PAC ID: 2264899244 Enrollment ID: I20230606003637 |
| Provider Name | Talmage Barth |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083141097 PECOS PAC ID: 8224392725 Enrollment ID: I20230621001485 |
| Provider Name | Logan C Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356916209 PECOS PAC ID: 9830591635 Enrollment ID: I20230630000835 |
| Provider Name | Joseph Ostler |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1235524802 PECOS PAC ID: 5496081192 Enrollment ID: I20230721002502 |
| Provider Name | Lindsey Blamires |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376259770 PECOS PAC ID: 4981065323 Enrollment ID: I20230801002149 |
| Provider Name | Lauren Clelland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336761063 PECOS PAC ID: 8325461841 Enrollment ID: I20230810003375 |
| Provider Name | Heather Mcguire |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1508806100 PECOS PAC ID: 4082644638 Enrollment ID: I20230811002959 |
| Provider Name | Raemi Dawn Nolevanko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063119212 PECOS PAC ID: 3971965211 Enrollment ID: I20230817002410 |
| Provider Name | Eric J Allen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508494071 PECOS PAC ID: 3375905557 Enrollment ID: I20230821001395 |
| Provider Name | Jill G Byers |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1902846629 PECOS PAC ID: 2567428279 Enrollment ID: I20230905003105 |
| Provider Name | Bradley Meyer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1073074720 PECOS PAC ID: 1557725587 Enrollment ID: I20230911000178 |
| Provider Name | Nathan Todd Sparks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710669874 PECOS PAC ID: 7517311764 Enrollment ID: I20230921004346 |
| Provider Name | Samantha Gonzales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962105429 PECOS PAC ID: 3173977253 Enrollment ID: I20230922001528 |
| Provider Name | Autumn Parizek |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1568149060 PECOS PAC ID: 8022462951 Enrollment ID: I20230927000703 |
| Provider Name | Timothy Strong |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1013354703 PECOS PAC ID: 7911148580 Enrollment ID: I20230927002904 |
| Provider Name | Bruce E. Gollub |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508855917 PECOS PAC ID: 0941464986 Enrollment ID: I20231019002085 |
| Provider Name | Stephanie B Duff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851076251 PECOS PAC ID: 4587010558 Enrollment ID: I20231026003887 |
| Provider Name | Ryan Delgatti |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1811419047 PECOS PAC ID: 0840564555 Enrollment ID: I20231030002457 |
| Provider Name | Nathan Frohne |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1760876676 PECOS PAC ID: 5395059182 Enrollment ID: I20231109001443 |
| Provider Name | Roxanne Mickelson |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1295081248 PECOS PAC ID: 3971977018 Enrollment ID: I20231122001020 |
| Provider Name | Brandi a Bartholomew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437835287 PECOS PAC ID: 5193173995 Enrollment ID: I20231204002209 |
| Provider Name | Kayler N Detmer |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1760112627 PECOS PAC ID: 5395193163 Enrollment ID: I20231205001019 |
| Provider Name | Brenda Renteria Loera |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1851022107 PECOS PAC ID: 4981053824 Enrollment ID: I20231218001485 |
| Provider Name | Benjamin H. Feldman |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1588829402 PECOS PAC ID: 6103046297 Enrollment ID: I20240219000878 |
| Provider Name | Kaitlin R Munns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083498554 PECOS PAC ID: 1153765946 Enrollment ID: I20240220003916 |
| Provider Name | Alan S. Bakes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922118876 PECOS PAC ID: 6204274939 Enrollment ID: I20240401001839 |
| Provider Name | Daniel Johnson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1013774868 PECOS PAC ID: 3274971106 Enrollment ID: I20240410003021 |
| Provider Name | Devin Edward Miles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992487896 PECOS PAC ID: 3274973946 Enrollment ID: I20240429000414 |
| Provider Name | Murali Maheswaran |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1912984139 PECOS PAC ID: 8527000884 Enrollment ID: I20240531000290 |
| Provider Name | Blaine Gibby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013443555 PECOS PAC ID: 0648694893 Enrollment ID: I20240604000729 |
| Provider Name | Krystin Nicole Hedeen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164284691 PECOS PAC ID: 9133662380 Enrollment ID: I20240617002411 |
| Provider Name | Tyler Slade |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881191260 PECOS PAC ID: 4688073315 Enrollment ID: I20240621001536 |
| Provider Name | Daniel Ripley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841829728 PECOS PAC ID: 2062836307 Enrollment ID: I20240719002314 |
| Provider Name | Ethan J Belnap |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1174204846 PECOS PAC ID: 4587100516 Enrollment ID: I20240725002697 |
| Provider Name | Keeley Coffee |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1194568824 PECOS PAC ID: 6608313408 Enrollment ID: I20240729004358 |
| Provider Name | Neil P Corbett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245866185 PECOS PAC ID: 0840611372 Enrollment ID: I20240730004143 |
| Provider Name | Spencer Funk |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1417516949 PECOS PAC ID: 4587102330 Enrollment ID: I20240812003726 |
| Provider Name | Samuel Holley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447719489 PECOS PAC ID: 8527431048 Enrollment ID: I20240820000992 |
| Provider Name | Nikolaus Konrad Neudorf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174142244 PECOS PAC ID: 8527485192 Enrollment ID: I20240821001570 |
| Provider Name | Grace Ripley |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588293203 PECOS PAC ID: 8921422460 Enrollment ID: I20240821002581 |
| Provider Name | Jason Ching |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396304929 PECOS PAC ID: 8022557206 Enrollment ID: I20240902000550 |
| Provider Name | Mckay Avondet |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1497382626 PECOS PAC ID: 9537583430 Enrollment ID: I20240916003823 |
| Provider Name | Erin Elizabeth Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518719111 PECOS PAC ID: 5294276366 Enrollment ID: I20240917003982 |
| Provider Name | Rashelle Annalee Reynolds |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1295431567 PECOS PAC ID: 8426599424 Enrollment ID: I20240918000585 |
| Provider Name | Michelle Imani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699510404 PECOS PAC ID: 2466983721 Enrollment ID: I20240927001602 |
| Provider Name | Evan Seamons |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154950335 PECOS PAC ID: 2062834898 Enrollment ID: I20240927001956 |
| Provider Name | Maria Saiz Quintana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285878272 PECOS PAC ID: 8426234089 Enrollment ID: I20241008000906 |
| Provider Name | Reatta Omoth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063256584 PECOS PAC ID: 7810429875 Enrollment ID: I20241015002326 |
| Provider Name | Madison Christine Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003642190 PECOS PAC ID: 5597297374 Enrollment ID: I20241017003186 |
| Provider Name | Tiara Littledyke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588904049 PECOS PAC ID: 1153737655 Enrollment ID: I20241023000896 |
| Provider Name | Ronald Hebard |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1467529305 PECOS PAC ID: 0244302123 Enrollment ID: I20241111001601 |
| Provider Name | Krystan Kimble |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1346868163 PECOS PAC ID: 2860926664 Enrollment ID: I20241115003315 |
| Provider Name | Uneeb Qureshi |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1376049262 PECOS PAC ID: 0345780821 Enrollment ID: I20241119001339 |
| Provider Name | Samuel Barker |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1972941375 PECOS PAC ID: 0547552242 Enrollment ID: I20241120003298 |
| Provider Name | Cameron Dodd |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962130963 PECOS PAC ID: 5092240143 Enrollment ID: I20241126001245 |
| Provider Name | Stacey Hallmark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144565276 PECOS PAC ID: 4880120484 Enrollment ID: I20241205003474 |
| Provider Name | Heather Marie Deuel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518638071 PECOS PAC ID: 0648706259 Enrollment ID: I20241205003751 |
| Provider Name | Kristen Varian |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639621766 PECOS PAC ID: 4385016088 Enrollment ID: I20241224000096 |
| Provider Name | Jeffrey Leibman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1457079592 PECOS PAC ID: 8628505948 Enrollment ID: I20241227002828 |
| Provider Name | Matthew Gill |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1699822833 PECOS PAC ID: 7517191158 Enrollment ID: I20250103001794 |
| Provider Name | Mckayla Ann Lively |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093538852 PECOS PAC ID: 3870021678 Enrollment ID: I20250107003185 |
| Provider Name | Reena Camoens |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467434910 PECOS PAC ID: 4183657844 Enrollment ID: I20250129001990 |
| Provider Name | Ajay Labroo |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1831199371 PECOS PAC ID: 7416924279 Enrollment ID: I20250220003261 |
| Provider Name | Brad L Helquist |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568296465 PECOS PAC ID: 9133645054 Enrollment ID: I20250423003731 |
| Provider Name | Donna L Benjamin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811289226 PECOS PAC ID: 6800065483 Enrollment ID: I20250606001038 |
| Provider Name | Kalle Kang |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1780626630 PECOS PAC ID: 7113828344 Enrollment ID: I20250606003336 |
| Provider Name | Sarah Johnson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1164315966 PECOS PAC ID: 9931610805 Enrollment ID: I20250617002946 |
| Provider Name | Jenifer Lynn Hopkins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982266797 PECOS PAC ID: 6608387287 Enrollment ID: I20250619002035 |
| Provider Name | Rebecca Ann Molina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184416935 PECOS PAC ID: 8325554819 Enrollment ID: I20250722001668 |
| Provider Name | Tyler Wayne Wheeler |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1972124121 PECOS PAC ID: 2365864295 Enrollment ID: I20250722002951 |
| Provider Name | Alma Iyon Soud |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326785254 PECOS PAC ID: 1456731967 Enrollment ID: I20250723001121 |
| Provider Name | Kovic Shane Bailey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194467688 PECOS PAC ID: 2062899222 Enrollment ID: I20250725002456 |
| Provider Name | Sean Eric Mcmillan |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1558353821 PECOS PAC ID: 5799790747 Enrollment ID: I20250807003013 |
| Provider Name | Michael Cameron Sweeney |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1396943114 PECOS PAC ID: 4082866579 Enrollment ID: I20250818003945 |
| Provider Name | Demsie Butler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457098386 PECOS PAC ID: 0042690687 Enrollment ID: I20250827003197 |
| Provider Name | Lin Xia |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1447041777 PECOS PAC ID: 1850800871 Enrollment ID: I20250905004440 |
| Provider Name | Taryn Palmer |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1669817482 PECOS PAC ID: 8325288681 Enrollment ID: I20251007003326 |
| Provider Name | Miranda L Higham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386137073 PECOS PAC ID: 9133616592 Enrollment ID: I20251017002313 |
| Provider Name | Mehul P Shah |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1184036378 PECOS PAC ID: 4880986793 Enrollment ID: I20251023004852 |
| Provider Name | Ian Greenberg |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1649791542 PECOS PAC ID: 8527339621 Enrollment ID: I20251029003037 |
| Provider Name | Brian Dooreck |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1306848965 PECOS PAC ID: 9739173238 Enrollment ID: I20251107003951 |
| Provider Name | David Morris |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1952367393 PECOS PAC ID: 3971504168 Enrollment ID: I20251113002517 |
| Provider Name | Blake Paul Williams |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1306647722 PECOS PAC ID: 9931691805 Enrollment ID: I20251126003977 |
| Provider Name | Katherine Strunk |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1750789723 PECOS PAC ID: 8628394434 Enrollment ID: I20251129000736 |
| Provider Name | Aaron MD Lewis |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1063585743 PECOS PAC ID: 5193987071 Enrollment ID: I20251210003897 |
| Provider Name | Sabo Tanimu |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1417063793 PECOS PAC ID: 1254404304 Enrollment ID: I20251218004650 |
| Provider Name | Spencer Kelsey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356737795 PECOS PAC ID: 1153817572 Enrollment ID: I20260109000190 |
| Provider Name | Jon Robert Vanderweele |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1598737801 PECOS PAC ID: 8729332556 Enrollment ID: I20260116001782 |
| Provider Name | Sybil Tifuh Dingha Abeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871462234 PECOS PAC ID: 9537646807 Enrollment ID: I20260119000519 |
| Provider Name | Michael Weaver |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1720427974 PECOS PAC ID: 5395966816 Enrollment ID: I20260121003829 |
| Provider Name | Abdul-qader Alarhayem |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1053676049 PECOS PAC ID: 5799102737 Enrollment ID: I20260206002649 |
| Provider Name | Carrie Alicia Richins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790955797 PECOS PAC ID: 0446731947 Enrollment ID: I20260223003310 |
| Provider Name | Maverick Mitton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396602249 PECOS PAC ID: 5395229876 Enrollment ID: I20260323002606 |
| Provider Name | Connie Enriquez-orozco |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912554395 PECOS PAC ID: 8729562079 Enrollment ID: I20260324003844 |
| Provider Name | Michael Shaw |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295010148 PECOS PAC ID: 1254686900 Enrollment ID: I20260330002179 |
| Provider Name | Patricia Krisar White |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578958930 PECOS PAC ID: 8820387806 Enrollment ID: I20260429004216 |
| Provider Name | Mark Mcconnell |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1184942039 PECOS PAC ID: 8820228059 Enrollment ID: I20260506002436 |
| Provider Name | Erin Mabey |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1467262162 PECOS PAC ID: 4183154370 Enrollment ID: I20260506003046 |
| Provider Name | Christopher Denham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336775204 PECOS PAC ID: 2062811102 Enrollment ID: I20260512004052 |
| Provider Name | Joseph Anthony Rattenni |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396372207 PECOS PAC ID: 1951726645 Enrollment ID: I20260604003963 |
Family Health Services Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 Morningside Dr, Twin Falls, ID 83301 Phone: 208-733-6507 Fax: 208-813-6337 |
Tripp Family Medicine, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1411 Fillmore St, Suite 600, Twin Falls, ID 83301 Phone: 208-933-4400 Fax: 208-933-4401 |
Warren Dopson MD, PC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 706 N College Rd Ste A, Twin Falls, ID 83301 Phone: 208-736-8006 Fax: 208-736-8007 |
Twin Falls Imaging & Diagnostic Center LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1330 Filer Ave E, Twin Falls, ID 83301 Phone: 208-732-1205 Fax: 208-736-2413 |
Twin Falls Imaging & Diagnostic Center LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 562 Shoup Ave W, Twin Falls, ID 83301 Phone: 208-732-1205 Fax: 208-736-2413 |
Blue Lakes Gastroenterology, PLLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 775 Pole Line Rd W, Suite 203, Twin Falls, ID 83301 Phone: 208-814-8300 Fax: 208-733-8970 |