| Tri-county Memorial Hospital, Inc. | |
|
18606 Ervin St Whitehall WI 54773-8613 | |
| (715) 538-4355 | |
| (715) 538-2151 |
| Full Name | Tri-county Memorial Hospital, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 18606 Ervin St, Whitehall, Wisconsin |
| Authorized Official Name and Position | Roxane Kay Schleich (CFO, REGIONAL) |
| Authorized Official Contact | 6087753839 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-county Memorial Hospital, Inc. 18601 Lincoln St Whitehall WI 54773-8605 Ph: (715) 538-4361 | Tri-county Memorial Hospital, Inc. 18606 Ervin St Whitehall WI 54773-8613 Ph: (715) 538-4355 |
| NPI Number | 1417201864 |
|---|---|
| Provider Enumeration Date | 11/07/2012 |
| Last Update Date | 11/03/2018 |
| Medicare PECOS PAC ID | 4587642418 |
|---|---|
| Medicare Enrollment ID | O20040708000696 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417201864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (Wisconsin) | Primary |
| Provider Name | Stephen C Copps |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548265804 PECOS PAC ID: 8325942360 Enrollment ID: I20031121000442 |
| Provider Name | Roger W Kwong |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1740286855 PECOS PAC ID: 4082512538 Enrollment ID: I20031222000728 |
| Provider Name | Emmanuel A Omoba |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346342342 PECOS PAC ID: 7517868938 Enrollment ID: I20040119000403 |
| Provider Name | Kurt R Oettel |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1770585051 PECOS PAC ID: 2860393121 Enrollment ID: I20040119000664 |
| Provider Name | Murray S Donovan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1598747263 PECOS PAC ID: 9638066236 Enrollment ID: I20040228000458 |
| Provider Name | Gregory E Salton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861502023 PECOS PAC ID: 4688561087 Enrollment ID: I20040301001108 |
| Provider Name | Shekhar S Sane |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740207711 PECOS PAC ID: 9830086248 Enrollment ID: I20040301001145 |
| Provider Name | Uma Suriyanarayanan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841217809 PECOS PAC ID: 9638066053 Enrollment ID: I20040301001222 |
| Provider Name | Daniel C Bloomgarden |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1821019639 PECOS PAC ID: 7517854961 Enrollment ID: I20040302000091 |
| Provider Name | Gordon L Johnson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1932105061 PECOS PAC ID: 2668361098 Enrollment ID: I20040313000292 |
| Provider Name | Pieter John Vanderlijn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1437188091 PECOS PAC ID: 5698666717 Enrollment ID: I20040320000078 |
| Provider Name | Daniel F Schraith |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1316941388 PECOS PAC ID: 1759374952 Enrollment ID: I20040405000968 |
| Provider Name | Emily D Rae |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659373827 PECOS PAC ID: 5597755736 Enrollment ID: I20040518000582 |
| Provider Name | Kelly A Carothers |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003936857 PECOS PAC ID: 4789665969 Enrollment ID: I20040525000610 |
| Provider Name | Philip Richard Albert |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073619623 PECOS PAC ID: 1052395647 Enrollment ID: I20040614000081 |
| Provider Name | Steven W Whitford |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1073507075 PECOS PAC ID: 5597739193 Enrollment ID: I20040820000206 |
| Provider Name | Mary L Goodsett |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1053316778 PECOS PAC ID: 4789658014 Enrollment ID: I20040823001269 |
| Provider Name | Raju G Ailiani |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831192194 PECOS PAC ID: 8426024647 Enrollment ID: I20040908001130 |
| Provider Name | Christopher M Eberlein |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629073739 PECOS PAC ID: 3375510324 Enrollment ID: I20040910000600 |
| Provider Name | Lori Sue Stoey Weber |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1235133976 PECOS PAC ID: 8426025362 Enrollment ID: I20040910001289 |
| Provider Name | Alan D Pratt |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1871595074 PECOS PAC ID: 8921076985 Enrollment ID: I20040917001180 |
| Provider Name | Lisa A Sullivan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326029935 PECOS PAC ID: 7113996976 Enrollment ID: I20040928001141 |
| Provider Name | Muhammad S Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447367974 PECOS PAC ID: 2264492198 Enrollment ID: I20041015000055 |
| Provider Name | Mary S Alvarado |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1962404194 PECOS PAC ID: 8325000672 Enrollment ID: I20041029000580 |
| Provider Name | Stephen J Handrich |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265454003 PECOS PAC ID: 5496717621 Enrollment ID: I20041101000128 |
| Provider Name | Michael Case |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1497750459 PECOS PAC ID: 3779546155 Enrollment ID: I20041106000055 |
| Provider Name | Ewa Plagman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548262744 PECOS PAC ID: 4981668985 Enrollment ID: I20041118000925 |
| Provider Name | Brian R Manske |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043213895 PECOS PAC ID: 1557264850 Enrollment ID: I20050106000861 |
| Provider Name | Kurt J Ziegelbein |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1205830809 PECOS PAC ID: 6901709260 Enrollment ID: I20050117000126 |
| Provider Name | Lonnie D Simmons |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851395735 PECOS PAC ID: 2668386707 Enrollment ID: I20050117000212 |
| Provider Name | Stephanie L Carroll |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942205356 PECOS PAC ID: 0345292033 Enrollment ID: I20050210000352 |
| Provider Name | Aditya A Sukhwal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104881259 PECOS PAC ID: 8527014570 Enrollment ID: I20050323000822 |
| Provider Name | Kevin M Jaeger |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1144226697 PECOS PAC ID: 9335186816 Enrollment ID: I20050415000525 |
| Provider Name | Laura K Marchiando |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568466183 PECOS PAC ID: 1759282585 Enrollment ID: I20050722000527 |
| Provider Name | Ghazwan Katmeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518945831 PECOS PAC ID: 3375432933 Enrollment ID: I20050829000050 |
| Provider Name | Elizabeth R Bade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184676207 PECOS PAC ID: 2668404666 Enrollment ID: I20050909000587 |
| Provider Name | Gordon G Zeng |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1801891460 PECOS PAC ID: 1658304951 Enrollment ID: I20050916000515 |
| Provider Name | Molly E Willenbring |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225006646 PECOS PAC ID: 4183645856 Enrollment ID: I20051208000903 |
| Provider Name | Amit P Kulkarni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710939996 PECOS PAC ID: 5698780211 Enrollment ID: I20060217000228 |
| Provider Name | Shaima K Sulemankhil |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427092196 PECOS PAC ID: 8224094149 Enrollment ID: I20060227000633 |
| Provider Name | David F Bleidorn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801824461 PECOS PAC ID: 1759391493 Enrollment ID: I20060426000308 |
| Provider Name | Barbara L Knisely |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326083874 PECOS PAC ID: 0749291623 Enrollment ID: I20060505000916 |
| Provider Name | Anna M Myklebust |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114956232 PECOS PAC ID: 5294746178 Enrollment ID: I20060505000926 |
| Provider Name | Bruce A Polender |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992707194 PECOS PAC ID: 0345243952 Enrollment ID: I20060822000232 |
| Provider Name | Robert S Zink |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730183336 PECOS PAC ID: 7719981430 Enrollment ID: I20060911000414 |
| Provider Name | Vallie M Kaprelian |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629043302 PECOS PAC ID: 7416846811 Enrollment ID: I20061003000714 |
| Provider Name | Kathy A Boe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316037047 PECOS PAC ID: 9830191360 Enrollment ID: I20070212000614 |
| Provider Name | Benjamin Wedro |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477557114 PECOS PAC ID: 1052346988 Enrollment ID: I20070216000337 |
| Provider Name | Keith E Baynes |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1598842742 PECOS PAC ID: 8224136734 Enrollment ID: I20070607000087 |
| Provider Name | Jon D Rawling |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912907403 PECOS PAC ID: 9537269915 Enrollment ID: I20070713000731 |
| Provider Name | Jennifer Lynn Drexler |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750594461 PECOS PAC ID: 4789776303 Enrollment ID: I20070827000594 |
| Provider Name | John R Houskamp |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023063732 PECOS PAC ID: 6709880966 Enrollment ID: I20071031000465 |
| Provider Name | Brett S Whyte |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730198896 PECOS PAC ID: 4587648035 Enrollment ID: I20071109000477 |
| Provider Name | Andrea Rae Maliszewski |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1124218995 PECOS PAC ID: 5597853101 Enrollment ID: I20071115000300 |
| Provider Name | Richard E Long |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215933122 PECOS PAC ID: 4587745880 Enrollment ID: I20080111000736 |
| Provider Name | Smita Y Rajasekaran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154367662 PECOS PAC ID: 8820053440 Enrollment ID: I20080204000693 |
| Provider Name | Jessica E Thesing |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1003090507 PECOS PAC ID: 2062595200 Enrollment ID: I20080212000363 |
| Provider Name | Marija Zakarija |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932136181 PECOS PAC ID: 6103868450 Enrollment ID: I20080225000239 |
| Provider Name | Mary G Dudley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1558366658 PECOS PAC ID: 8022195213 Enrollment ID: I20080412000034 |
| Provider Name | Belinda C Hickey |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1578568051 PECOS PAC ID: 4587741780 Enrollment ID: I20080412000072 |
| Provider Name | Chad M Thurman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801890660 PECOS PAC ID: 6901978725 Enrollment ID: I20080710000286 |
| Provider Name | Jody M Riherd |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1922041623 PECOS PAC ID: 1052484888 Enrollment ID: I20080726000008 |
| Provider Name | Gabriela Dumitran |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1831393164 PECOS PAC ID: 8123194800 Enrollment ID: I20080903000444 |
| Provider Name | Shawn D Sedgwick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679559298 PECOS PAC ID: 3072595677 Enrollment ID: I20080916000266 |
| Provider Name | Quinn H Holzheimer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497700769 PECOS PAC ID: 0648283283 Enrollment ID: I20081108000044 |
| Provider Name | Janice L Schroeder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831344134 PECOS PAC ID: 8628131729 Enrollment ID: I20090115000718 |
| Provider Name | Michael A Witcik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568625713 PECOS PAC ID: 3072679372 Enrollment ID: I20090312000174 |
| Provider Name | Benny Kusuma |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073734133 PECOS PAC ID: 5698825883 Enrollment ID: I20090610000023 |
| Provider Name | Sarah R Pendley |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1922063239 PECOS PAC ID: 8820149438 Enrollment ID: I20090622000332 |
| Provider Name | Carl William Decker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154421279 PECOS PAC ID: 3375592975 Enrollment ID: I20090724000137 |
| Provider Name | Kazi Zahir Rayhan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508060229 PECOS PAC ID: 1456405679 Enrollment ID: I20090821000239 |
| Provider Name | John J Conzemius |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568467827 PECOS PAC ID: 1557400611 Enrollment ID: I20091202000422 |
| Provider Name | Darin Dean Damstra |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558503102 PECOS PAC ID: 6901943679 Enrollment ID: I20100116000285 |
| Provider Name | Edward H Riley |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1962404921 PECOS PAC ID: 6507909256 Enrollment ID: I20100203000894 |
| Provider Name | Ricky J Waniger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366446098 PECOS PAC ID: 0143116970 Enrollment ID: I20100206000205 |
| Provider Name | Joan E Filla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851396741 PECOS PAC ID: 8022153659 Enrollment ID: I20100306000029 |
| Provider Name | Paul T Stanton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528092160 PECOS PAC ID: 1951436146 Enrollment ID: I20100312000509 |
| Provider Name | Rodney A Erickson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528058021 PECOS PAC ID: 1850421785 Enrollment ID: I20100618000764 |
| Provider Name | Gregory M Knorr |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053317305 PECOS PAC ID: 6002949161 Enrollment ID: I20100727000564 |
| Provider Name | Ward M Brown |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1720082381 PECOS PAC ID: 5991774879 Enrollment ID: I20100813001017 |
| Provider Name | Michael L Bottcher |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1922002609 PECOS PAC ID: 1052445970 Enrollment ID: I20100813001053 |
| Provider Name | Laurence Clifford Berg |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1437153392 PECOS PAC ID: 5597864561 Enrollment ID: I20100816001043 |
| Provider Name | Scott D Brunk |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497759062 PECOS PAC ID: 8426182106 Enrollment ID: I20100817000723 |
| Provider Name | Ross M Cerniglia |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1578640793 PECOS PAC ID: 6507990215 Enrollment ID: I20100817001001 |
| Provider Name | Vydunas G Tumas |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831150424 PECOS PAC ID: 1850425307 Enrollment ID: I20100819000112 |
| Provider Name | William C Bucknam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548206360 PECOS PAC ID: 7012921943 Enrollment ID: I20100820001127 |
| Provider Name | Jedadiah J Schaller |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790964773 PECOS PAC ID: 9234263070 Enrollment ID: I20100914001159 |
| Provider Name | Frank J Aberger |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1396748711 PECOS PAC ID: 8628018678 Enrollment ID: I20100921000162 |
| Provider Name | Eric W Voter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558365288 PECOS PAC ID: 2567494701 Enrollment ID: I20100928000504 |
| Provider Name | James L Groskreutz |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1548265127 PECOS PAC ID: 9234184243 Enrollment ID: I20101020001437 |
| Provider Name | Daniel P Wolbrink |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700041274 PECOS PAC ID: 6507910460 Enrollment ID: I20101102001463 |
| Provider Name | Katrina R Hammel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780894527 PECOS PAC ID: 7012084965 Enrollment ID: I20101108000728 |
| Provider Name | Julie S Zink |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669476263 PECOS PAC ID: 9133314487 Enrollment ID: I20101111001042 |
| Provider Name | Kristen A Olson Baines |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649498387 PECOS PAC ID: 7214122498 Enrollment ID: I20101112001079 |
| Provider Name | Milton J Schmida |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1669477006 PECOS PAC ID: 4789740697 Enrollment ID: I20101112001197 |
| Provider Name | Susan G Maclellan-tobert |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1952304834 PECOS PAC ID: 0941498984 Enrollment ID: I20101217000352 |
| Provider Name | Jeffrey D Hillesland |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730184219 PECOS PAC ID: 5395933881 Enrollment ID: I20101228000574 |
| Provider Name | Richard J Wittchow |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1477557122 PECOS PAC ID: 8022114669 Enrollment ID: I20110117000173 |
| Provider Name | David J Lofgren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346247236 PECOS PAC ID: 0446220602 Enrollment ID: I20110118000219 |
| Provider Name | Ngozi Nduka |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1902137201 PECOS PAC ID: 3476682246 Enrollment ID: I20110124000786 |
| Provider Name | Milan E Folkers |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1619064094 PECOS PAC ID: 2365449626 Enrollment ID: I20110201000151 |
| Provider Name | Sumaiya Siddiqi |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1679607709 PECOS PAC ID: 9931206638 Enrollment ID: I20110311000315 |
| Provider Name | Ragasri Kumar Merkes |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1699930594 PECOS PAC ID: 5799969523 Enrollment ID: I20110401000867 |
| Provider Name | Mark S Topolski |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1386618916 PECOS PAC ID: 0941497762 Enrollment ID: I20110621000574 |
| Provider Name | Jerald F Tabbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497807796 PECOS PAC ID: 7810175221 Enrollment ID: I20110706000354 |
| Provider Name | William A Bishop |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487819223 PECOS PAC ID: 3072790740 Enrollment ID: I20110808000571 |
| Provider Name | Andrew Weiss |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356509384 PECOS PAC ID: 3375671449 Enrollment ID: I20110808000594 |
| Provider Name | Gabriel L Marsh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114182045 PECOS PAC ID: 9234308297 Enrollment ID: I20110808000615 |
| Provider Name | Mateen Fatima Abidi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730333980 PECOS PAC ID: 9830369073 Enrollment ID: I20110826000242 |
| Provider Name | Eric M Jakubowski |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326266867 PECOS PAC ID: 5890965032 Enrollment ID: I20110826000300 |
| Provider Name | Carrie L Kramer |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1861518409 PECOS PAC ID: 3375713340 Enrollment ID: I20110830000481 |
| Provider Name | John A Zernia |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124022728 PECOS PAC ID: 5496889420 Enrollment ID: I20111019000845 |
| Provider Name | Benjamin S Orozco |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407017833 PECOS PAC ID: 5890963136 Enrollment ID: I20111102000057 |
| Provider Name | Deidre M Rippl |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1598949026 PECOS PAC ID: 0345412011 Enrollment ID: I20111117000117 |
| Provider Name | Charles H Klos |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1710906813 PECOS PAC ID: 3678732500 Enrollment ID: I20120312000673 |
| Provider Name | Todd L Ebbert |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366641383 PECOS PAC ID: 5395911754 Enrollment ID: I20120627000426 |
| Provider Name | Vijay Bandhakavi |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1184887473 PECOS PAC ID: 1951557859 Enrollment ID: I20120808000880 |
| Provider Name | Leah Rose Moellers Thompson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053547562 PECOS PAC ID: 1951570530 Enrollment ID: I20120820000655 |
| Provider Name | Heather J Wichman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043471972 PECOS PAC ID: 7618124090 Enrollment ID: I20120821000401 |
| Provider Name | Matthew Nelson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720030422 PECOS PAC ID: 7214969039 Enrollment ID: I20121011000925 |
| Provider Name | Michael Alan Zimmer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477712750 PECOS PAC ID: 2860670841 Enrollment ID: I20121012000817 |
| Provider Name | Lucas J Hammell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528252764 PECOS PAC ID: 7315020641 Enrollment ID: I20121022000515 |
| Provider Name | Sean P Mcgrann |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1629394325 PECOS PAC ID: 8820248818 Enrollment ID: I20121029000580 |
| Provider Name | Joshua J Whitson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437441730 PECOS PAC ID: 6002068079 Enrollment ID: I20121221000076 |
| Provider Name | Sarah J Staff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881944858 PECOS PAC ID: 0345492724 Enrollment ID: I20121228000191 |
| Provider Name | Alexander Macario Villareal |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1609094457 PECOS PAC ID: 1658462445 Enrollment ID: I20130123000568 |
| Provider Name | Stephen T Nitz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518958651 PECOS PAC ID: 7719060144 Enrollment ID: I20130213000469 |
| Provider Name | Ashley E St Clair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598035768 PECOS PAC ID: 7911143110 Enrollment ID: I20130412000444 |
| Provider Name | Tiffany Marinier |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144343161 PECOS PAC ID: 6901992981 Enrollment ID: I20130806000114 |
| Provider Name | Aaron J Zivney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174834568 PECOS PAC ID: 7315189222 Enrollment ID: I20130806000189 |
| Provider Name | Eric T Moore |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417156142 PECOS PAC ID: 9638210339 Enrollment ID: I20130808000119 |
| Provider Name | Jason Robert Darrah |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1447577176 PECOS PAC ID: 7719129196 Enrollment ID: I20130814000681 |
| Provider Name | Hjalti Gudmundsson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1164632980 PECOS PAC ID: 1759415672 Enrollment ID: I20130816000402 |
| Provider Name | Ezana Muluneh Azene |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073715975 PECOS PAC ID: 3476708322 Enrollment ID: I20130823001105 |
| Provider Name | Jennifer A Mclellan |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164620480 PECOS PAC ID: 4284881426 Enrollment ID: I20131002000123 |
| Provider Name | Christy D Short |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659699833 PECOS PAC ID: 5799910055 Enrollment ID: I20131023000730 |
| Provider Name | Kevin L Schoepel |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1841211067 PECOS PAC ID: 6800861105 Enrollment ID: I20140122001325 |
| Provider Name | Erica R Neumeister |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225118698 PECOS PAC ID: 3274434105 Enrollment ID: I20140409000032 |
| Provider Name | Jamie Hosmer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841452927 PECOS PAC ID: 8527209386 Enrollment ID: I20140507001005 |
| Provider Name | Christen Chamberland |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1194984716 PECOS PAC ID: 7416171624 Enrollment ID: I20140610000049 |
| Provider Name | Nathaniel L Stepp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942491030 PECOS PAC ID: 0244492262 Enrollment ID: I20140729002887 |
| Provider Name | David Peter Megremis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982606620 PECOS PAC ID: 2163493396 Enrollment ID: I20141006002402 |
| Provider Name | Kimberly B Breidenbach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972893071 PECOS PAC ID: 9234451832 Enrollment ID: I20141210001655 |
| Provider Name | Megan M Klomps-mcclung |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255614681 PECOS PAC ID: 3779805296 Enrollment ID: I20141211000300 |
| Provider Name | Christopher M Lowry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730445008 PECOS PAC ID: 5294963112 Enrollment ID: I20150102000836 |
| Provider Name | Devin C Simonson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1760749626 PECOS PAC ID: 1153643580 Enrollment ID: I20150109002029 |
| Provider Name | Esosa G Odigie-okon |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1588815914 PECOS PAC ID: 0446573240 Enrollment ID: I20150603001080 |
| Provider Name | Sunil A Mutgi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225358906 PECOS PAC ID: 8729228226 Enrollment ID: I20150706002556 |
| Provider Name | Andrew C Colburn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639420888 PECOS PAC ID: 5890008825 Enrollment ID: I20150721000533 |
| Provider Name | Matthew A Weeks |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619239936 PECOS PAC ID: 6103130653 Enrollment ID: I20150729006803 |
| Provider Name | Zachary R Clements |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689933434 PECOS PAC ID: 3072828763 Enrollment ID: I20150810001439 |
| Provider Name | Rachel A Biemiller |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790927390 PECOS PAC ID: 0042453680 Enrollment ID: I20151002002623 |
| Provider Name | Stephen Wade Rieke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780054015 PECOS PAC ID: 0042520587 Enrollment ID: I20151112001221 |
| Provider Name | Debra L Wade |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689673212 PECOS PAC ID: 9830169135 Enrollment ID: I20160107001777 |
| Provider Name | Fatemeh S Jannati |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1174878706 PECOS PAC ID: 8729204789 Enrollment ID: I20160216002415 |
| Provider Name | Eric M Blaschke |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386957678 PECOS PAC ID: 0941515365 Enrollment ID: I20160513000825 |
| Provider Name | Carolina Q See |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831135201 PECOS PAC ID: 4284630195 Enrollment ID: I20160519001442 |
| Provider Name | Julie A Vircks |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1790048494 PECOS PAC ID: 4880990571 Enrollment ID: I20160608001341 |
| Provider Name | Tara R Lang |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366414328 PECOS PAC ID: 0446278675 Enrollment ID: I20160610001757 |
| Provider Name | Christopher Cogbill |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1326141599 PECOS PAC ID: 8921248121 Enrollment ID: I20160725002277 |
| Provider Name | Grzegorz T Gurda |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1255652061 PECOS PAC ID: 8820249618 Enrollment ID: I20160802001116 |
| Provider Name | John Renelt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1861465478 PECOS PAC ID: 6103736145 Enrollment ID: I20160804000359 |
| Provider Name | Jacob Pederson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932441318 PECOS PAC ID: 3577857184 Enrollment ID: I20160804001087 |
| Provider Name | Trixie L Murphy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174976203 PECOS PAC ID: 3870887995 Enrollment ID: I20160811001224 |
| Provider Name | Andrew D Prather |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790947943 PECOS PAC ID: 9133415615 Enrollment ID: I20160912001700 |
| Provider Name | Gregory M Eddy |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1407219959 PECOS PAC ID: 4082913629 Enrollment ID: I20160922000165 |
| Provider Name | Alacia M Pierce |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1962957712 PECOS PAC ID: 3971881467 Enrollment ID: I20161103002478 |
| Provider Name | Kelly M Lay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629513783 PECOS PAC ID: 1355624792 Enrollment ID: I20170210000269 |
| Provider Name | Adam Zorn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073795761 PECOS PAC ID: 1759516651 Enrollment ID: I20170313001820 |
| Provider Name | Edward Rodenkirch |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326458951 PECOS PAC ID: 0143513556 Enrollment ID: I20170807002174 |
| Provider Name | Matthew R Mueller |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1013394717 PECOS PAC ID: 4688947245 Enrollment ID: I20170901000090 |
| Provider Name | Megan Marie Daveau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356851992 PECOS PAC ID: 7214294651 Enrollment ID: I20171120002575 |
| Provider Name | Deena Athas |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1457526170 PECOS PAC ID: 9032287537 Enrollment ID: I20171122001518 |
| Provider Name | Tanya R Mudgett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114438348 PECOS PAC ID: 4587922455 Enrollment ID: I20171223000017 |
| Provider Name | Sharada Kamalanatha Chaitra |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1629165899 PECOS PAC ID: 9133289051 Enrollment ID: I20180413001234 |
| Provider Name | Janel Lanae Ward |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285885087 PECOS PAC ID: 8527255603 Enrollment ID: I20180418000817 |
| Provider Name | Kunal M Shah |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1730504150 PECOS PAC ID: 8123381209 Enrollment ID: I20180425000021 |
| Provider Name | Edward Zhovtis |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1952556664 PECOS PAC ID: 1850453101 Enrollment ID: I20180510000091 |
| Provider Name | Marcus W Bickford |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285070722 PECOS PAC ID: 7810125945 Enrollment ID: I20180531001920 |
| Provider Name | Joseph D Verzwyvelt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801186127 PECOS PAC ID: 6800036914 Enrollment ID: I20180711000966 |
| Provider Name | John M Billings |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1235495524 PECOS PAC ID: 6901033935 Enrollment ID: I20180719000983 |
| Provider Name | Emily M Bresette |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013302173 PECOS PAC ID: 4082907498 Enrollment ID: I20180731003924 |
| Provider Name | Hafiz Fakih |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1730434119 PECOS PAC ID: 2062727480 Enrollment ID: I20180803001767 |
| Provider Name | Anthony P Zbacnik |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346508033 PECOS PAC ID: 2163705922 Enrollment ID: I20180809006071 |
| Provider Name | Maude L Kettenmann |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760611057 PECOS PAC ID: 5991922494 Enrollment ID: I20180815001448 |
| Provider Name | Chaithanya Bhaskar |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1306193925 PECOS PAC ID: 2163730631 Enrollment ID: I20180823003117 |
| Provider Name | Martin Williamson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1740778646 PECOS PAC ID: 2567719768 Enrollment ID: I20180920000262 |
| Provider Name | Abdallah Sanaani |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1689919144 PECOS PAC ID: 8628328580 Enrollment ID: I20180924000228 |
| Provider Name | Suren Ravuri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104063536 PECOS PAC ID: 2860647682 Enrollment ID: I20181210001581 |
| Provider Name | Jordan Matthew Thompson |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1780940155 PECOS PAC ID: 9537460001 Enrollment ID: I20181215000043 |
| Provider Name | Ralph G. Althouse |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1477636405 PECOS PAC ID: 3678463387 Enrollment ID: I20181217000605 |
| Provider Name | Tammy G Buchanan |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1487627022 PECOS PAC ID: 9335108463 Enrollment ID: I20190104000721 |
| Provider Name | Joseph D Goldman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417993767 PECOS PAC ID: 6901067511 Enrollment ID: I20190114000010 |
| Provider Name | Jordan L Ludwigson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538693783 PECOS PAC ID: 6002186772 Enrollment ID: I20190212000071 |
| Provider Name | Aaron D Christians |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376077578 PECOS PAC ID: 5294004875 Enrollment ID: I20190213001167 |
| Provider Name | Vanessa Lane Trim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427448265 PECOS PAC ID: 6103167317 Enrollment ID: I20190416000723 |
| Provider Name | Melanie Bratcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245791144 PECOS PAC ID: 0840533923 Enrollment ID: I20190513000170 |
| Provider Name | Daniel L Cox |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417319112 PECOS PAC ID: 3375836497 Enrollment ID: I20190610001077 |
| Provider Name | Kevin Hanson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164885406 PECOS PAC ID: 1355635640 Enrollment ID: I20190715000666 |
| Provider Name | Andrew Jesson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114371713 PECOS PAC ID: 2163775024 Enrollment ID: I20190717002457 |
| Provider Name | Mitchell Lee Sheley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093102378 PECOS PAC ID: 5496056160 Enrollment ID: I20190719002825 |
| Provider Name | Warangkana Chokesuwattanaskul |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306030481 PECOS PAC ID: 4789717034 Enrollment ID: I20190723002551 |
| Provider Name | Wah Wah Htun |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1083943179 PECOS PAC ID: 9032412465 Enrollment ID: I20190913000771 |
| Provider Name | Abhishek Sharma |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1811276587 PECOS PAC ID: 3274806823 Enrollment ID: I20191112001445 |
| Provider Name | Anika Nina Watson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073776126 PECOS PAC ID: 2062668064 Enrollment ID: I20191204001269 |
| Provider Name | Ekaterina Sikorskaya |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275823866 PECOS PAC ID: 3173847241 Enrollment ID: I20200221000467 |
| Provider Name | Ann L Lapacinski |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1750850871 PECOS PAC ID: 1850631979 Enrollment ID: I20200413003704 |
| Provider Name | Stefan M Brettfeld |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1154718005 PECOS PAC ID: 2668786583 Enrollment ID: I20200806001022 |
| Provider Name | Adam J Haggerty |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043741507 PECOS PAC ID: 7214278647 Enrollment ID: I20200812002229 |
| Provider Name | Luke Wenzel |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669823571 PECOS PAC ID: 8123313285 Enrollment ID: I20200827000526 |
| Provider Name | Taeha Kim |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1457762205 PECOS PAC ID: 4486922671 Enrollment ID: I20200901003313 |
| Provider Name | Patrick A Self |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1225458300 PECOS PAC ID: 3375848435 Enrollment ID: I20200909001319 |
| Provider Name | David S Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760916845 PECOS PAC ID: 5698045201 Enrollment ID: I20200916000278 |
| Provider Name | Taj Kattapuram |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699902569 PECOS PAC ID: 3375702418 Enrollment ID: I20201007001736 |
| Provider Name | Darren J Knox |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558892869 PECOS PAC ID: 8921379884 Enrollment ID: I20201008000603 |
| Provider Name | Justin C Dyer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962666271 PECOS PAC ID: 8426228941 Enrollment ID: I20201015000835 |
| Provider Name | Mark C Wickre |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063830628 PECOS PAC ID: 9436454451 Enrollment ID: I20201105000580 |
| Provider Name | Thomas K Ceballos |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1215975719 PECOS PAC ID: 7719089242 Enrollment ID: I20201117000723 |
| Provider Name | Samantha L Stark |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962866343 PECOS PAC ID: 2567744857 Enrollment ID: I20201230000188 |
| Provider Name | Stephen F Israel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376539700 PECOS PAC ID: 8628045176 Enrollment ID: I20210107001265 |
| Provider Name | Gilda Boroumand |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326363102 PECOS PAC ID: 3375766348 Enrollment ID: I20210216001803 |
| Provider Name | Daniel Bade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376631077 PECOS PAC ID: 3173548450 Enrollment ID: I20210223002210 |
| Provider Name | Thomas E Dudley |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1174727093 PECOS PAC ID: 6002908068 Enrollment ID: I20210326001202 |
| Provider Name | Banke Agarwal |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1134137011 PECOS PAC ID: 4284779539 Enrollment ID: I20210428001977 |
| Provider Name | Luke C Helland |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457617193 PECOS PAC ID: 3678898558 Enrollment ID: I20210607001062 |
| Provider Name | Stephen J Bloechl |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1316181795 PECOS PAC ID: 8022231943 Enrollment ID: I20210615001681 |
| Provider Name | Joshua Westbrook |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851773204 PECOS PAC ID: 4981006525 Enrollment ID: I20210706001729 |
| Provider Name | Vikas S.r Koppurapu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235512922 PECOS PAC ID: 3678880580 Enrollment ID: I20210809000818 |
| Provider Name | Blaine G Stott |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780180612 PECOS PAC ID: 1355777293 Enrollment ID: I20210914000190 |
| Provider Name | Kim Thi Truong |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932528387 PECOS PAC ID: 7810393196 Enrollment ID: I20210914001947 |
| Provider Name | Sarah C Deyoung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780252759 PECOS PAC ID: 3173921137 Enrollment ID: I20211006002011 |
| Provider Name | Thanh Pham |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992237770 PECOS PAC ID: 6002157377 Enrollment ID: I20211007002945 |
| Provider Name | Matthew R Huspeni |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467993022 PECOS PAC ID: 6608140157 Enrollment ID: I20211011001843 |
| Provider Name | Patricia Fronk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396380572 PECOS PAC ID: 8921498809 Enrollment ID: I20211208001744 |
| Provider Name | Tiffany Lee Petersen |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1861169716 PECOS PAC ID: 4880085034 Enrollment ID: I20211222001153 |
| Provider Name | Thomas Luers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104270354 PECOS PAC ID: 3678865805 Enrollment ID: I20220111002271 |
| Provider Name | Ananth K Ravi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184856478 PECOS PAC ID: 6608186341 Enrollment ID: I20220408001834 |
| Provider Name | Ivica Vucic |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871779371 PECOS PAC ID: 5395872857 Enrollment ID: I20220428002090 |
| Provider Name | Jamal Janjua |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1366894370 PECOS PAC ID: 3274821426 Enrollment ID: I20220817002094 |
| Provider Name | Abigail L Strong |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1316442437 PECOS PAC ID: 1557784709 Enrollment ID: I20220824002134 |
| Provider Name | Maheedhar Gedela |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1104231216 PECOS PAC ID: 1658598651 Enrollment ID: I20220919002213 |
| Provider Name | Lacey J Schrader |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1093165656 PECOS PAC ID: 5092137737 Enrollment ID: I20220927002312 |
| Provider Name | Joseph M Aziz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073954475 PECOS PAC ID: 8527298983 Enrollment ID: I20221017002474 |
| Provider Name | Angela R Williams |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588843700 PECOS PAC ID: 0749347847 Enrollment ID: I20221130002096 |
| Provider Name | Erin K Davis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396088787 PECOS PAC ID: 1557663093 Enrollment ID: I20221212000567 |
| Provider Name | Theodore Toerne |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902814502 PECOS PAC ID: 0345231403 Enrollment ID: I20230131000898 |
| Provider Name | Caroline Marie Muzic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235858101 PECOS PAC ID: 5294106167 Enrollment ID: I20230201001261 |
| Provider Name | Nicole L Bjerke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245925395 PECOS PAC ID: 1557727922 Enrollment ID: I20230510002379 |
| Provider Name | Matthieu Mayer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528564861 PECOS PAC ID: 5991052078 Enrollment ID: I20230522001330 |
| Provider Name | Chad Roline |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710153986 PECOS PAC ID: 9335271709 Enrollment ID: I20230810002861 |
| Provider Name | Nathaniel J Lucey |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659996221 PECOS PAC ID: 5496179327 Enrollment ID: I20230816001635 |
| Provider Name | Ivan Kaspruk |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649890195 PECOS PAC ID: 1355703588 Enrollment ID: I20230818002468 |
| Provider Name | Michelle K Raabe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912535311 PECOS PAC ID: 2264813690 Enrollment ID: I20230827000133 |
| Provider Name | Xiangyun John Duan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083121941 PECOS PAC ID: 7810310851 Enrollment ID: I20230830000540 |
| Provider Name | Michelle Marie Cancel |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1093245581 PECOS PAC ID: 8224307095 Enrollment ID: I20231005000631 |
| Provider Name | Allicen Marie Waxlax |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841879244 PECOS PAC ID: 7810391471 Enrollment ID: I20231012002686 |
| Provider Name | Timothy Whitehead |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1871752428 PECOS PAC ID: 6800011636 Enrollment ID: I20231027001431 |
| Provider Name | Molly Senn Sygulla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619597606 PECOS PAC ID: 0042635807 Enrollment ID: I20231201001062 |
| Provider Name | Alexa V Becherer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194305318 PECOS PAC ID: 3779933718 Enrollment ID: I20240103001330 |
| Provider Name | Toni Kaye Duch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215175245 PECOS PAC ID: 5193176907 Enrollment ID: I20240105002027 |
| Provider Name | Christopher G. Schmid |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669718763 PECOS PAC ID: 7517318330 Enrollment ID: I20240105002513 |
| Provider Name | Megan E Barber |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1407274533 PECOS PAC ID: 6002118890 Enrollment ID: I20240213000615 |
| Provider Name | Ian B Young |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669769162 PECOS PAC ID: 0840446571 Enrollment ID: I20240302000012 |
| Provider Name | Bradley Emmerich |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801475447 PECOS PAC ID: 9133520364 Enrollment ID: I20240723002997 |
| Provider Name | Shawn P Wayne |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1295266443 PECOS PAC ID: 7315218369 Enrollment ID: I20240828000709 |
| Provider Name | Mitchell T Voter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477139210 PECOS PAC ID: 2466999107 Enrollment ID: I20240903001912 |