| University Of Texas Health Science Center At Tyler-facility-physician | |
|
11937 Us Highway 271 Tyler TX 75708-3154 | |
| (903) 877-3451 | |
| Not Available |
| Full Name | University Of Texas Health Science Center At Tyler-facility-physician |
|---|---|
| Speciality | Neuromusculoskeletal Medicine, Sports Medicine |
| Location | 11937 Us Highway 271, Tyler, Texas |
| Authorized Official Name and Position | Kris Kavasch (VP FINANCE/CFO) |
| Authorized Official Contact | 9038777399 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| University Of Texas Health Science Center At Tyler-facility-physician Po Box 731912 Dallas TX 75373-1912 Ph: (903) 877-7777 | University Of Texas Health Science Center At Tyler-facility-physician 11937 Us Highway 271 Tyler TX 75708-3154 Ph: (903) 877-3451 |
| NPI Number | 1063400778 |
|---|---|
| Provider Enumeration Date | 10/07/2005 |
| Last Update Date | 06/27/2019 |
| Medicare PECOS PAC ID | 4981699220 |
|---|---|
| Medicare Enrollment ID | O20040416001048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063400778 | NPI | - | NPPES |
| 127278302 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Stanislav Weiner |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1003801705 PECOS PAC ID: 0547164097 Enrollment ID: I20031125000711 |
| Provider Name | Paul Joonyeob Lim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942288634 PECOS PAC ID: 9739074543 Enrollment ID: I20040219000975 |
| Provider Name | Lewis G Smith |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1144380684 PECOS PAC ID: 9436047313 Enrollment ID: I20040310001142 |
| Provider Name | Joseph T Martins |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1407852700 PECOS PAC ID: 3870589104 Enrollment ID: I20040422000730 |
| Provider Name | Shara K Duggins Reed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497823223 PECOS PAC ID: 6204823578 Enrollment ID: I20040428001068 |
| Provider Name | Eric S Madore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982678884 PECOS PAC ID: 0941298053 Enrollment ID: I20040505001178 |
| Provider Name | Alexandria T Phan |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1821016148 PECOS PAC ID: 1951383165 Enrollment ID: I20040602000882 |
| Provider Name | Minh Le |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871583880 PECOS PAC ID: 0648252338 Enrollment ID: I20040605000248 |
| Provider Name | Ilanko Upendran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124051073 PECOS PAC ID: 1456333921 Enrollment ID: I20040607001249 |
| Provider Name | Schulundria S Williams |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1205821055 PECOS PAC ID: 6901889021 Enrollment ID: I20040722000633 |
| Provider Name | Robert L Boyne |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134128176 PECOS PAC ID: 2769452358 Enrollment ID: I20040729001615 |
| Provider Name | Todd P Smith |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1215902598 PECOS PAC ID: 8729059001 Enrollment ID: I20040802000726 |
| Provider Name | Kent Paul Webb |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1104892926 PECOS PAC ID: 3173594611 Enrollment ID: I20040805001310 |
| Provider Name | Brigham C Willis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1598701500 PECOS PAC ID: 8426024928 Enrollment ID: I20040907000723 |
| Provider Name | Michael David Bastasch |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1912962028 PECOS PAC ID: 4880653039 Enrollment ID: I20041005000380 |
| Provider Name | Toni L Richey |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1265560205 PECOS PAC ID: 1254390248 Enrollment ID: I20041006000169 |
| Provider Name | Glenda Rose Sealey |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1023017290 PECOS PAC ID: 5092776583 Enrollment ID: I20041019000604 |
| Provider Name | George G Gass |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1710981196 PECOS PAC ID: 9133033541 Enrollment ID: I20041023000225 |
| Provider Name | David Irwin Jones |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1366440596 PECOS PAC ID: 9234043647 Enrollment ID: I20041023000234 |
| Provider Name | Clarence Edward Brown |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538273180 PECOS PAC ID: 4486615366 Enrollment ID: I20041023000266 |
| Provider Name | Luis A Destarac Maselli |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1477513927 PECOS PAC ID: 3375504251 Enrollment ID: I20041023000284 |
| Provider Name | Katrina Yvonne Glover |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1144248501 PECOS PAC ID: 6901867506 Enrollment ID: I20041026000512 |
| Provider Name | Jennifer T Rippy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366497992 PECOS PAC ID: 5991767154 Enrollment ID: I20041029000732 |
| Provider Name | Richard R Yates |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1972503209 PECOS PAC ID: 5092778944 Enrollment ID: I20041110001309 |
| Provider Name | Patti Burk Olusola |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962490953 PECOS PAC ID: 1355305095 Enrollment ID: I20041112000992 |
| Provider Name | Michael Y Ashigbi |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1649275355 PECOS PAC ID: 3375592744 Enrollment ID: I20050113000132 |
| Provider Name | Karen K Wies |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609893270 PECOS PAC ID: 1951353523 Enrollment ID: I20050211000697 |
| Provider Name | Sharon Jean Martin Holm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275538035 PECOS PAC ID: 8022060961 Enrollment ID: I20050218000495 |
| Provider Name | Andrew Quiroz |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1023044583 PECOS PAC ID: 6901853142 Enrollment ID: I20050331000374 |
| Provider Name | Douglas R Flanders |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1629046057 PECOS PAC ID: 8123075389 Enrollment ID: I20050331000525 |
| Provider Name | Deborah L Plagenhoef |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1679512735 PECOS PAC ID: 3870540966 Enrollment ID: I20050331000854 |
| Provider Name | Stanley R Perkins |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1548299902 PECOS PAC ID: 2769439488 Enrollment ID: I20050405000950 |
| Provider Name | Shawn A Thomas |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1598798340 PECOS PAC ID: 2961459508 Enrollment ID: I20050405001208 |
| Provider Name | Derek T Mitchell |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1093744484 PECOS PAC ID: 3173562659 Enrollment ID: I20050426000343 |
| Provider Name | Joe P Cooley |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1891722542 PECOS PAC ID: 5294774667 Enrollment ID: I20050426001113 |
| Provider Name | Timothy J Twaddell |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1689610081 PECOS PAC ID: 1658310941 Enrollment ID: I20050426001398 |
| Provider Name | Joseph M Gonzales |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1487683983 PECOS PAC ID: 5991744633 Enrollment ID: I20050502000731 |
| Provider Name | Mark R Robbins |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1891797429 PECOS PAC ID: 1052353489 Enrollment ID: I20050525001274 |
| Provider Name | Robert Williams |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1144269697 PECOS PAC ID: 4486698255 Enrollment ID: I20050613000876 |
| Provider Name | Maxwell P Kwaku |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1083641534 PECOS PAC ID: 1557391802 Enrollment ID: I20050816000825 |
| Provider Name | Andrew L Schmitt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417001124 PECOS PAC ID: 6608897368 Enrollment ID: I20051209000589 |
| Provider Name | Joel Daniel Marcus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528044195 PECOS PAC ID: 8022022771 Enrollment ID: I20060201000689 |
| Provider Name | Robert C Winans |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1265460760 PECOS PAC ID: 3971518531 Enrollment ID: I20060217000610 |
| Provider Name | Mark D Roberts |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1780611897 PECOS PAC ID: 2860407368 Enrollment ID: I20060220000236 |
| Provider Name | Stephen P Rydzak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184656555 PECOS PAC ID: 0749193811 Enrollment ID: I20060908000408 |
| Provider Name | Robert B Tompkins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477537074 PECOS PAC ID: 4284639162 Enrollment ID: I20060927000481 |
| Provider Name | William D Tallmadge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912080813 PECOS PAC ID: 6103928668 Enrollment ID: I20070301000361 |
| Provider Name | Bruce E Ellerin |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1285635052 PECOS PAC ID: 1153392865 Enrollment ID: I20070620000446 |
| Provider Name | Jonathan W Buttram |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1497714984 PECOS PAC ID: 3072613199 Enrollment ID: I20070702000674 |
| Provider Name | Ndukwe Uduma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689768525 PECOS PAC ID: 4284635186 Enrollment ID: I20071015000445 |
| Provider Name | Oscar A Paniagua |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1831261809 PECOS PAC ID: 5193814101 Enrollment ID: I20071128000623 |
| Provider Name | Laurel Blackman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194752576 PECOS PAC ID: 5294816773 Enrollment ID: I20080123000152 |
| Provider Name | Andrew B Thyen |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1700878352 PECOS PAC ID: 2163400441 Enrollment ID: I20080228000413 |
| Provider Name | Andrew C Roberts |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1700826260 PECOS PAC ID: 9133191372 Enrollment ID: I20080311000649 |
| Provider Name | Robert B Wells |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1164536207 PECOS PAC ID: 8123104197 Enrollment ID: I20080401000206 |
| Provider Name | Mary A Mcinnis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134399751 PECOS PAC ID: 0446320188 Enrollment ID: I20080606000092 |
| Provider Name | John B Sims |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1801913710 PECOS PAC ID: 3779654546 Enrollment ID: I20080623000194 |
| Provider Name | Rajesh P Subramania |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588694525 PECOS PAC ID: 2668426081 Enrollment ID: I20080709000699 |
| Provider Name | Chris L Jacobson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1285805739 PECOS PAC ID: 8022181270 Enrollment ID: I20080721000638 |
| Provider Name | Jose A Serpa-alvarez |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1528239159 PECOS PAC ID: 7810060886 Enrollment ID: I20080724000087 |
| Provider Name | Kalpana K Basoor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104949460 PECOS PAC ID: 2365500485 Enrollment ID: I20081018000086 |
| Provider Name | Farzad Fakouri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043408495 PECOS PAC ID: 7517026859 Enrollment ID: I20081031000509 |
| Provider Name | Rodolfo Amaro-galvez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023006509 PECOS PAC ID: 7719049980 Enrollment ID: I20081222000570 |
| Provider Name | Jarett D Berry |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1134345275 PECOS PAC ID: 9739243288 Enrollment ID: I20090127000688 |
| Provider Name | Miguel A Vazquez |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1942269071 PECOS PAC ID: 4183780513 Enrollment ID: I20090309000659 |
| Provider Name | Paul M Fanning |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1972577419 PECOS PAC ID: 5890842793 Enrollment ID: I20090410000188 |
| Provider Name | Charla C Spencer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1700851193 PECOS PAC ID: 5698732345 Enrollment ID: I20090422000613 |
| Provider Name | Kyle J Smith |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1902817992 PECOS PAC ID: 7618028689 Enrollment ID: I20090702000352 |
| Provider Name | Misty D Herod |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1891939088 PECOS PAC ID: 1951453620 Enrollment ID: I20090710000540 |
| Provider Name | Melinda C Menard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992910624 PECOS PAC ID: 2961554027 Enrollment ID: I20090721000300 |
| Provider Name | Ralph J Turner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1013950997 PECOS PAC ID: 2961436928 Enrollment ID: I20090727000065 |
| Provider Name | Melissa M Gabel-alvarado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174856025 PECOS PAC ID: 2264579341 Enrollment ID: I20091021000753 |
| Provider Name | Amy A Bundy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518291988 PECOS PAC ID: 1850438615 Enrollment ID: I20091027000675 |
| Provider Name | Ted Willis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548236235 PECOS PAC ID: 0143287896 Enrollment ID: I20091027000899 |
| Provider Name | Leslie Couch |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1689663387 PECOS PAC ID: 9830237775 Enrollment ID: I20091112000541 |
| Provider Name | Paul Sharkey |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1912989690 PECOS PAC ID: 7113065731 Enrollment ID: I20091118000619 |
| Provider Name | Wayne Karaki |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871582924 PECOS PAC ID: 2264571710 Enrollment ID: I20091123000602 |
| Provider Name | Christine A Powell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639228141 PECOS PAC ID: 0840339149 Enrollment ID: I20091130000072 |
| Provider Name | Steven W Cox |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1831188457 PECOS PAC ID: 6709925852 Enrollment ID: I20091202000349 |
| Provider Name | Christine C Moulds-merritt |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1215904875 PECOS PAC ID: 0648319731 Enrollment ID: I20091202000754 |
| Provider Name | David Finlay |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790774925 PECOS PAC ID: 9133268089 Enrollment ID: I20091205000201 |
| Provider Name | Leo Holm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104815125 PECOS PAC ID: 2860531712 Enrollment ID: I20091205000204 |
| Provider Name | Dudley Goulden |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1336138742 PECOS PAC ID: 3678612520 Enrollment ID: I20091205000205 |
| Provider Name | Richard Wallace |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1083698609 PECOS PAC ID: 0446390108 Enrollment ID: I20091211000031 |
| Provider Name | H Lance Mandell |
|---|---|
| Provider Type | Practitioner - Hematology |
| Provider Identifiers | NPI Number: 1760432959 PECOS PAC ID: 1254396179 Enrollment ID: I20091217000196 |
| Provider Name | Chiagozie Nwasuruba |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548250574 PECOS PAC ID: 8022158278 Enrollment ID: I20091218000184 |
| Provider Name | Bolarinwa Olusola |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1790775724 PECOS PAC ID: 3870679749 Enrollment ID: I20100108000224 |
| Provider Name | William F Turner |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1790799856 PECOS PAC ID: 7416099320 Enrollment ID: I20100114000762 |
| Provider Name | John A Larrinaga |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275507204 PECOS PAC ID: 8224172069 Enrollment ID: I20100217000862 |
| Provider Name | John G Pogue |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225068695 PECOS PAC ID: 0446395560 Enrollment ID: I20100301000569 |
| Provider Name | Phyllis A Ramirez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811222532 PECOS PAC ID: 2062547128 Enrollment ID: I20100316000131 |
| Provider Name | Clyde F Sanford |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1528053857 PECOS PAC ID: 7315842317 Enrollment ID: I20100316000739 |
| Provider Name | Ray G Scardina |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447225115 PECOS PAC ID: 1355476029 Enrollment ID: I20100319000357 |
| Provider Name | Leslie E Tingle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871552943 PECOS PAC ID: 4385779735 Enrollment ID: I20100324000290 |
| Provider Name | Daren P Yeager |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417923111 PECOS PAC ID: 4284760950 Enrollment ID: I20100405000371 |
| Provider Name | David A Andreone |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1083786982 PECOS PAC ID: 3577504653 Enrollment ID: I20100518000145 |
| Provider Name | William A Elfarr |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1275542144 PECOS PAC ID: 7719961283 Enrollment ID: I20100528000226 |
| Provider Name | Ruben L Garcia |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1639188501 PECOS PAC ID: 7719961184 Enrollment ID: I20100601000491 |
| Provider Name | Wesley E Pemberton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972752954 PECOS PAC ID: 1052442985 Enrollment ID: I20100622000043 |
| Provider Name | James E Magee |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1619123403 PECOS PAC ID: 9234288671 Enrollment ID: I20100720000946 |
| Provider Name | Allison L Hennigan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730335829 PECOS PAC ID: 2062545536 Enrollment ID: I20100804000553 |
| Provider Name | Savitha Shastry |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1518174465 PECOS PAC ID: 9335263409 Enrollment ID: I20100825001025 |
| Provider Name | James R Menard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447446653 PECOS PAC ID: 6305961707 Enrollment ID: I20100908000801 |
| Provider Name | Thomas C Bright |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1811937378 PECOS PAC ID: 1951373190 Enrollment ID: I20101026000167 |
| Provider Name | Lakeisha Deeann Marsh Green |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578729752 PECOS PAC ID: 3971661745 Enrollment ID: I20101026000566 |
| Provider Name | Dinesh K Sangana |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669434908 PECOS PAC ID: 3072572072 Enrollment ID: I20101101000656 |
| Provider Name | Arielle S Lee |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1679578389 PECOS PAC ID: 8123056769 Enrollment ID: I20101123001242 |
| Provider Name | Robert M Droder |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1275538985 PECOS PAC ID: 7012055288 Enrollment ID: I20101124000477 |
| Provider Name | Myrtha Basile |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1083619704 PECOS PAC ID: 9032165949 Enrollment ID: I20101124000799 |
| Provider Name | Daniel A Mccarthy |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1831128396 PECOS PAC ID: 2365630316 Enrollment ID: I20101217000576 |
| Provider Name | Eldon Steele |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1134158769 PECOS PAC ID: 4183812142 Enrollment ID: I20101217000700 |
| Provider Name | Ronald Rudak |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1093744559 PECOS PAC ID: 6406044247 Enrollment ID: I20101221000828 |
| Provider Name | Qin Huang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720271489 PECOS PAC ID: 1557543360 Enrollment ID: I20110315000343 |
| Provider Name | Joshua W Stringer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750517926 PECOS PAC ID: 1557545084 Enrollment ID: I20110407000690 |
| Provider Name | Frederick Tinio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114902111 PECOS PAC ID: 5193793735 Enrollment ID: I20110523000644 |
| Provider Name | Ketan Patel |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1174721310 PECOS PAC ID: 1557539798 Enrollment ID: I20110714000331 |
| Provider Name | Charles R Walker |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609068071 PECOS PAC ID: 9931239183 Enrollment ID: I20120703000296 |
| Provider Name | Santosh N Hakkapakki |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568641371 PECOS PAC ID: 8022199082 Enrollment ID: I20120714000076 |
| Provider Name | Jeffrey N Wherry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881735025 PECOS PAC ID: 1850557067 Enrollment ID: I20120716000313 |
| Provider Name | Julie V Philley |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1922135151 PECOS PAC ID: 1759537806 Enrollment ID: I20120806000888 |
| Provider Name | Megan S Devine |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1255541108 PECOS PAC ID: 4981850682 Enrollment ID: I20120813000543 |
| Provider Name | Matthew J Leveno |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1619186954 PECOS PAC ID: 0244486835 Enrollment ID: I20120815000120 |
| Provider Name | Erminia Massarelli |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1982855326 PECOS PAC ID: 5395994792 Enrollment ID: I20120928000349 |
| Provider Name | Justin D Sacks |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285926659 PECOS PAC ID: 9032354865 Enrollment ID: I20130328000070 |
| Provider Name | David S Prudhome |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1437494879 PECOS PAC ID: 8820235179 Enrollment ID: I20130506000461 |
| Provider Name | James G Fox |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1962602789 PECOS PAC ID: 3476795113 Enrollment ID: I20130809000214 |
| Provider Name | Katherine S Root |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083932818 PECOS PAC ID: 2567606445 Enrollment ID: I20130916000064 |
| Provider Name | Kendra Hoyle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518011642 PECOS PAC ID: 9133032204 Enrollment ID: I20140222000182 |
| Provider Name | Viet Tran |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1235465311 PECOS PAC ID: 4587887666 Enrollment ID: I20140516001710 |
| Provider Name | Vandana Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285871681 PECOS PAC ID: 2466598354 Enrollment ID: I20140611001416 |
| Provider Name | Marc Edward Usrey |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1952504045 PECOS PAC ID: 8628100542 Enrollment ID: I20140822002061 |
| Provider Name | Andres A Bueno |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952612350 PECOS PAC ID: 3971721473 Enrollment ID: I20140825002623 |
| Provider Name | Natalie Inge Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356351977 PECOS PAC ID: 6800797325 Enrollment ID: I20141103001805 |
| Provider Name | Emad Essam Shoukry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053318857 PECOS PAC ID: 1759353337 Enrollment ID: I20141231001191 |
| Provider Name | Admir Seferovic |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477763795 PECOS PAC ID: 3173702933 Enrollment ID: I20150114001966 |
| Provider Name | Michelle B Parker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093153645 PECOS PAC ID: 8224356183 Enrollment ID: I20150406001664 |
| Provider Name | Rachael Rowland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336585835 PECOS PAC ID: 3274763958 Enrollment ID: I20150430001949 |
| Provider Name | Stephen Sepulveda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356601611 PECOS PAC ID: 3375863970 Enrollment ID: I20150521002375 |
| Provider Name | Hani A Yousif |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386999761 PECOS PAC ID: 7416268974 Enrollment ID: I20150624002511 |
| Provider Name | Hishaam Ismael |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1841443645 PECOS PAC ID: 7618289653 Enrollment ID: I20150706001922 |
| Provider Name | Jason S Murry |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1184851040 PECOS PAC ID: 5698904068 Enrollment ID: I20150710000450 |
| Provider Name | Julia Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528439783 PECOS PAC ID: 9638489990 Enrollment ID: I20151117001685 |
| Provider Name | John A Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679943914 PECOS PAC ID: 2567762172 Enrollment ID: I20151204000354 |
| Provider Name | Ann Md Abrameit |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1407229693 PECOS PAC ID: 2365742848 Enrollment ID: I20151207000688 |
| Provider Name | Kari L Kennel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750753406 PECOS PAC ID: 4385945062 Enrollment ID: I20151222002377 |
| Provider Name | Carla Wang-kocik |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1093948333 PECOS PAC ID: 0143369736 Enrollment ID: I20151228002307 |
| Provider Name | Robin Strait |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447615919 PECOS PAC ID: 8123320801 Enrollment ID: I20160112002917 |
| Provider Name | Ifeanyi Izediuno |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043443401 PECOS PAC ID: 3779726146 Enrollment ID: I20160303000357 |
| Provider Name | Anthony J Mcgee |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1982062477 PECOS PAC ID: 7618274234 Enrollment ID: I20160328000596 |
| Provider Name | Christopher A Perro |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1346462496 PECOS PAC ID: 9537338322 Enrollment ID: I20160504000294 |
| Provider Name | Alicia Rose Adkison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104287929 PECOS PAC ID: 2466741368 Enrollment ID: I20160517000377 |
| Provider Name | Umair Sohail |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1376879940 PECOS PAC ID: 0143468066 Enrollment ID: I20160519001286 |
| Provider Name | Austin T Eagleton |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1568753291 PECOS PAC ID: 3577861004 Enrollment ID: I20160627000380 |
| Provider Name | Philip Ramirez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992143549 PECOS PAC ID: 1254639693 Enrollment ID: I20160711000058 |
| Provider Name | Brandon Riley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033478961 PECOS PAC ID: 5991098501 Enrollment ID: I20160720000035 |
| Provider Name | Rashmi Verma |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1790919512 PECOS PAC ID: 1153574819 Enrollment ID: I20160803002924 |
| Provider Name | Paul A Critelli |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1831351790 PECOS PAC ID: 9638465529 Enrollment ID: I20160831002536 |
| Provider Name | Kamran Shahid |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1336370642 PECOS PAC ID: 4284939257 Enrollment ID: I20161202000318 |
| Provider Name | Philip Pippin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902218241 PECOS PAC ID: 6305144809 Enrollment ID: I20161209001349 |
| Provider Name | Kavitha R Donthireddy |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1508048513 PECOS PAC ID: 0648352930 Enrollment ID: I20161212000303 |
| Provider Name | James B Buchinger |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1063567634 PECOS PAC ID: 4082700273 Enrollment ID: I20161213001622 |
| Provider Name | Adam C Hertel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629480017 PECOS PAC ID: 4587962105 Enrollment ID: I20170113000640 |
| Provider Name | Juan P Garrido Morales |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285073288 PECOS PAC ID: 5496054504 Enrollment ID: I20170131001527 |
| Provider Name | Luke Range |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134665078 PECOS PAC ID: 8527341577 Enrollment ID: I20170216002619 |
| Provider Name | Kelli N Rollins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538608971 PECOS PAC ID: 6305120312 Enrollment ID: I20170310000577 |
| Provider Name | Robyn Moran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548791502 PECOS PAC ID: 9739465287 Enrollment ID: I20170417001560 |
| Provider Name | Eric Christopher Flavill |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1417157249 PECOS PAC ID: 4587890348 Enrollment ID: I20170511001499 |
| Provider Name | Meghan Leann Creath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649720806 PECOS PAC ID: 4789951765 Enrollment ID: I20170523000373 |
| Provider Name | Sadia Malik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598995359 PECOS PAC ID: 5991941908 Enrollment ID: I20170619001941 |
| Provider Name | Varalaxmi Nannaka |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1003198391 PECOS PAC ID: 5597033290 Enrollment ID: I20170621002968 |
| Provider Name | David A Denney |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235679283 PECOS PAC ID: 4789954090 Enrollment ID: I20170719002910 |
| Provider Name | Annala J Shirley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215468129 PECOS PAC ID: 1557631272 Enrollment ID: I20170727002807 |
| Provider Name | My-huyen Tran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558773820 PECOS PAC ID: 7214236421 Enrollment ID: I20170801000668 |
| Provider Name | Taylor Torrence Teague |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578983128 PECOS PAC ID: 1951672724 Enrollment ID: I20170814000228 |
| Provider Name | Mestawet Teka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225341563 PECOS PAC ID: 3870812357 Enrollment ID: I20170901000392 |
| Provider Name | Sonja Hampshire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669983482 PECOS PAC ID: 2567729320 Enrollment ID: I20171202000192 |
| Provider Name | Shawn Tai |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1306005798 PECOS PAC ID: 9537311600 Enrollment ID: I20171204000770 |
| Provider Name | Abdelrazig B Suliman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396163408 PECOS PAC ID: 0042519142 Enrollment ID: I20171211000944 |
| Provider Name | Jonathan B King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174023352 PECOS PAC ID: 5799048468 Enrollment ID: I20180410002406 |
| Provider Name | Lindsey Ann Stockton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447632880 PECOS PAC ID: 3870874720 Enrollment ID: I20180702001396 |
| Provider Name | Michael Wirsching |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1598119810 PECOS PAC ID: 6305105818 Enrollment ID: I20180710002139 |
| Provider Name | Bryan Juan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538549175 PECOS PAC ID: 6800194382 Enrollment ID: I20180711001091 |
| Provider Name | Ryan Tubre |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1821434630 PECOS PAC ID: 7719283365 Enrollment ID: I20180712000666 |
| Provider Name | Lorena Santoro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114307790 PECOS PAC ID: 5991003485 Enrollment ID: I20180716001418 |
| Provider Name | Yury Ragoza |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689054264 PECOS PAC ID: 4284932674 Enrollment ID: I20180716001915 |
| Provider Name | Kelli Kay Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942787528 PECOS PAC ID: 1557612769 Enrollment ID: I20180927002445 |
| Provider Name | Soran Anwar Mahmood |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396056974 PECOS PAC ID: 2466797428 Enrollment ID: I20181219001053 |
| Provider Name | Yasin Ibrahim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659787067 PECOS PAC ID: 0749526986 Enrollment ID: I20190109002403 |
| Provider Name | Jamon Blood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316333552 PECOS PAC ID: 8426341926 Enrollment ID: I20190130001747 |
| Provider Name | Jared Anthony Crook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417420498 PECOS PAC ID: 6103164777 Enrollment ID: I20190207000470 |
| Provider Name | Tiffany Paige Hill |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730299306 PECOS PAC ID: 9739428806 Enrollment ID: I20190307000934 |
| Provider Name | Tara Ann Sadler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578024717 PECOS PAC ID: 5991048019 Enrollment ID: I20190513001870 |
| Provider Name | Andrew Frank Navetta |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1144631151 PECOS PAC ID: 7113210303 Enrollment ID: I20190612000291 |
| Provider Name | Jessica A Bracks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275982589 PECOS PAC ID: 0143513721 Enrollment ID: I20190626001800 |
| Provider Name | Charles Joseph Keith |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1487098240 PECOS PAC ID: 1153561873 Enrollment ID: I20190813003688 |
| Provider Name | Stephanie Jernigan Simmons |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821514001 PECOS PAC ID: 5092047142 Enrollment ID: I20191023001193 |
| Provider Name | Ralph Hemerson De Similien |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013355676 PECOS PAC ID: 9335414010 Enrollment ID: I20200117001820 |
| Provider Name | Pamela Mcshane |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1093791808 PECOS PAC ID: 4880782366 Enrollment ID: I20200127000525 |
| Provider Name | Stephanie Erin Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437786035 PECOS PAC ID: 0547691495 Enrollment ID: I20200511001349 |
| Provider Name | Tiya Shalyse Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154696359 PECOS PAC ID: 6507148764 Enrollment ID: I20200807001467 |
| Provider Name | Leanne Dada |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1386028157 PECOS PAC ID: 8426302514 Enrollment ID: I20200810000021 |
| Provider Name | Katherine E Kerr |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427433226 PECOS PAC ID: 6507147535 Enrollment ID: I20200810003690 |
| Provider Name | Kevin Saunders |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225486426 PECOS PAC ID: 3274805031 Enrollment ID: I20200826001881 |
| Provider Name | Pelin D Strebler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326657792 PECOS PAC ID: 2163840679 Enrollment ID: I20200916000198 |
| Provider Name | Muhammad Kafeel Sarwar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013389030 PECOS PAC ID: 5496092512 Enrollment ID: I20200922002580 |
| Provider Name | Halle Ross-young |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912512468 PECOS PAC ID: 2769801638 Enrollment ID: I20200925000702 |
| Provider Name | David Rice |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902867260 PECOS PAC ID: 1456452796 Enrollment ID: I20201022004220 |
| Provider Name | Melodie Marian Blackmon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1689162257 PECOS PAC ID: 3476963489 Enrollment ID: I20201103001293 |
| Provider Name | Bhavani Suryadevara |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710211578 PECOS PAC ID: 6002041001 Enrollment ID: I20210115001146 |
| Provider Name | Robert Michael Galbraith |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1609802859 PECOS PAC ID: 4284719386 Enrollment ID: I20210427000269 |
| Provider Name | Shaynna Mann |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508228933 PECOS PAC ID: 6406144328 Enrollment ID: I20210518001081 |
| Provider Name | Rebecca Peebles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245678457 PECOS PAC ID: 0446575385 Enrollment ID: I20210524000258 |
| Provider Name | Jennifer Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861074775 PECOS PAC ID: 5294134821 Enrollment ID: I20210601002050 |
| Provider Name | Archana Sagar |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1710308002 PECOS PAC ID: 2466851803 Enrollment ID: I20210604000809 |
| Provider Name | Andrew Oshiro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841724648 PECOS PAC ID: 0547532327 Enrollment ID: I20210708000533 |
| Provider Name | Brandon Keith Van Deman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629693841 PECOS PAC ID: 2769884923 Enrollment ID: I20210709001815 |
| Provider Name | Phuong Trinh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720585979 PECOS PAC ID: 9830444819 Enrollment ID: I20210709002599 |
| Provider Name | Scott Hatcherson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629569041 PECOS PAC ID: 4183976830 Enrollment ID: I20210720000870 |
| Provider Name | Daniela Hagenasr |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609373273 PECOS PAC ID: 3971868399 Enrollment ID: I20210810000587 |
| Provider Name | Mingxue Arguello |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1164882429 PECOS PAC ID: 4587927066 Enrollment ID: I20210811001327 |
| Provider Name | Sujitha Nandimandalam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114334752 PECOS PAC ID: 2860702693 Enrollment ID: I20210812000861 |
| Provider Name | Ahsan Hafeez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669807244 PECOS PAC ID: 9931470960 Enrollment ID: I20210914000613 |
| Provider Name | Clayton Thomas Hodges |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1154680486 PECOS PAC ID: 1254682792 Enrollment ID: I20210929001256 |
| Provider Name | Peter Charles Mcneill |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609373943 PECOS PAC ID: 5395000798 Enrollment ID: I20211228000628 |
| Provider Name | Roger Pearce |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295706273 PECOS PAC ID: 2961569918 Enrollment ID: I20220502000791 |
| Provider Name | Andrew Mellon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285164913 PECOS PAC ID: 6709150121 Enrollment ID: I20220518002742 |
| Provider Name | Mohammad Samiullah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578025607 PECOS PAC ID: 6608257134 Enrollment ID: I20220715000033 |
| Provider Name | Amy S Mikhael |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356907786 PECOS PAC ID: 0143601682 Enrollment ID: I20220715000103 |
| Provider Name | Derek Ryan Helsley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265991566 PECOS PAC ID: 4688904980 Enrollment ID: I20220718001179 |
| Provider Name | Elizabeth Bui |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1093194268 PECOS PAC ID: 0345556759 Enrollment ID: I20220810001246 |
| Provider Name | Gina Nickels-nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376526921 PECOS PAC ID: 5294630786 Enrollment ID: I20220811001878 |
| Provider Name | Yi Zhao |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588227953 PECOS PAC ID: 4587993779 Enrollment ID: I20220817002341 |
| Provider Name | Mary Suzanne Baker |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275269037 PECOS PAC ID: 2567847411 Enrollment ID: I20220914000718 |
| Provider Name | Kiley Anne Schneider |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033846787 PECOS PAC ID: 8224414859 Enrollment ID: I20221004003295 |
| Provider Name | Elizabeth N Modene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184132797 PECOS PAC ID: 9931564713 Enrollment ID: I20230501000551 |
| Provider Name | Cheryl Mccullumsmith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801977954 PECOS PAC ID: 0042312522 Enrollment ID: I20230516001785 |
| Provider Name | Barbara Switzer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1437592607 PECOS PAC ID: 5698059913 Enrollment ID: I20230525001694 |
| Provider Name | Bixuan Lin |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1992236707 PECOS PAC ID: 1557791043 Enrollment ID: I20230602000562 |
| Provider Name | John David Martino |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285255877 PECOS PAC ID: 3678994746 Enrollment ID: I20230622000701 |
| Provider Name | Alyssa Weyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598386039 PECOS PAC ID: 2163843285 Enrollment ID: I20230629002332 |
| Provider Name | Jamie Librizzi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346478617 PECOS PAC ID: 5698924561 Enrollment ID: I20230710000503 |
| Provider Name | Tanveer M Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003343278 PECOS PAC ID: 0941661797 Enrollment ID: I20230726004048 |
| Provider Name | Christine Kang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497376081 PECOS PAC ID: 6608207949 Enrollment ID: I20230731004095 |
| Provider Name | Cade Wesley Clark |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679061907 PECOS PAC ID: 9830550235 Enrollment ID: I20230802000053 |
| Provider Name | Cassandra Jo Rasmussen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003296930 PECOS PAC ID: 1759745706 Enrollment ID: I20230911001184 |
| Provider Name | Asher J Minor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073177747 PECOS PAC ID: 9234588740 Enrollment ID: I20231209000042 |
| Provider Name | Shannon B Meador |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568741346 PECOS PAC ID: 6406105345 Enrollment ID: I20231219000268 |
| Provider Name | Jeanne Nizigiye |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598833253 PECOS PAC ID: 1658268768 Enrollment ID: I20240206001483 |
| Provider Name | Sandeep Denduluri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457528218 PECOS PAC ID: 2961545348 Enrollment ID: I20240418001855 |
| Provider Name | Jennifer Flores |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013761774 PECOS PAC ID: 9335580133 Enrollment ID: I20240510001620 |
| Provider Name | David August |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477700185 PECOS PAC ID: 7416017991 Enrollment ID: I20240514001548 |
| Provider Name | Ghanshyam Ghelani |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1407297385 PECOS PAC ID: 0840591590 Enrollment ID: I20240530000242 |
| Provider Name | Molly Trejo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053949313 PECOS PAC ID: 4789128828 Enrollment ID: I20240701002052 |
| Provider Name | Janki Patel |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1548723513 PECOS PAC ID: 2163757378 Enrollment ID: I20240705000420 |
| Provider Name | Kavitha Ganesan |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1427402551 PECOS PAC ID: 2769716901 Enrollment ID: I20240709003713 |
| Provider Name | Warda Md Maqsood |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1811493315 PECOS PAC ID: 9234534579 Enrollment ID: I20240723004784 |
| Provider Name | Heidys Prieto |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255185674 PECOS PAC ID: 6800334996 Enrollment ID: I20240820004826 |
| Provider Name | Devanshi Mehta |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1831576784 PECOS PAC ID: 7315249703 Enrollment ID: I20240905004844 |
| Provider Name | Monika Kumaraswamy |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1891938106 PECOS PAC ID: 5698075315 Enrollment ID: I20240929000104 |
| Provider Name | Mladjen Veselinovic |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1427430214 PECOS PAC ID: 7618286154 Enrollment ID: I20241015000190 |
| Provider Name | Courtney Vinson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1730562620 PECOS PAC ID: 3375077811 Enrollment ID: I20241106003832 |
| Provider Name | Jill Ann Quiambao |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265583504 PECOS PAC ID: 6507754405 Enrollment ID: I20241126001924 |
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