| Verne Gibbs Health Center | |
|
107 H Street East Poplar MT 59255 | |
| (406) 768-3491 | |
| (406) 768-3491 |
| Full Name | Verne Gibbs Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 107 H Street East, Poplar, Montana |
| Authorized Official Name and Position | Marjorie Spotted Bird (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4067683491 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Verne Gibbs Health Center Po Box 67 Poplar MT 59255-0067 Ph: (406) 768-3491 | Verne Gibbs Health Center 107 H Street East Poplar MT 59255 Ph: (406) 768-3491 |
| NPI Number | 1972694602 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 12/21/2023 |
| Medicare PECOS PAC ID | 9638081623 |
|---|---|
| Medicare Enrollment ID | O20031106000399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972694602 | NPI | - | NPPES |
| 2210068 | Medicaid | MT | |
| 000009301 | Other | MT | BC/BS OF MONTANA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| 344600000X | Taxi | (* (Not Available)) | Secondary |
| Provider Name | Kate G Case |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1487831798 PECOS PAC ID: 3476459306 Enrollment ID: I20031210000868 |
| Provider Name | David J Langford |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1255337549 PECOS PAC ID: 7719883404 Enrollment ID: I20031211001145 |
| Provider Name | Richard C Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457481343 PECOS PAC ID: 4082512751 Enrollment ID: I20031219000666 |
| Provider Name | David A Mark |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023166840 PECOS PAC ID: 4981502010 Enrollment ID: I20031226000240 |
| Provider Name | Marie D Percy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013966837 PECOS PAC ID: 9931194255 Enrollment ID: I20040416000837 |
| Provider Name | Thomas J Schreiner |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922062967 PECOS PAC ID: 8527058338 Enrollment ID: I20040513001598 |
| Provider Name | Peggy Jo Whiteplume |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1649334905 PECOS PAC ID: 4981681962 Enrollment ID: I20040707001058 |
| Provider Name | Stephen W Wegner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114088259 PECOS PAC ID: 8426027137 Enrollment ID: I20040929000879 |
| Provider Name | Russell J Case |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780667261 PECOS PAC ID: 7517926736 Enrollment ID: I20041023000218 |
| Provider Name | James B Whitworth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629065891 PECOS PAC ID: 6507824646 Enrollment ID: I20041221000805 |
| Provider Name | Jane W Wuchinich |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285799486 PECOS PAC ID: 3072571769 Enrollment ID: I20041228000690 |
| Provider Name | Varghese Parambi |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1386645257 PECOS PAC ID: 2961498704 Enrollment ID: I20050104000993 |
| Provider Name | John W Randall |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1982695524 PECOS PAC ID: 8820074156 Enrollment ID: I20050107000114 |
| Provider Name | Richard Tenney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700093846 PECOS PAC ID: 3678510443 Enrollment ID: I20050413000432 |
| Provider Name | Mary Clair Mcguire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386764819 PECOS PAC ID: 6103863832 Enrollment ID: I20050413000984 |
| Provider Name | James S Rogers |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1861481525 PECOS PAC ID: 9931180320 Enrollment ID: I20050708000274 |
| Provider Name | Dwayne A Booth |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1427110022 PECOS PAC ID: 9335178730 Enrollment ID: I20050805000597 |
| Provider Name | Leroy A Clark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578527115 PECOS PAC ID: 0446223325 Enrollment ID: I20050808001065 |
| Provider Name | Samir Vinodkumar Joshi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1528036787 PECOS PAC ID: 3274508874 Enrollment ID: I20050928000820 |
| Provider Name | Rosaline K Begay |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134291479 PECOS PAC ID: 3274559331 Enrollment ID: I20051018000690 |
| Provider Name | Ernest J Gray |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922168012 PECOS PAC ID: 8820017908 Enrollment ID: I20051117000630 |
| Provider Name | Laurel A Christians |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114933876 PECOS PAC ID: 7810965480 Enrollment ID: I20060109000822 |
| Provider Name | Michael R Tilus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700963873 PECOS PAC ID: 3173531415 Enrollment ID: I20060329000319 |
| Provider Name | Keith B Johnston |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1265589402 PECOS PAC ID: 1254341795 Enrollment ID: I20060428000202 |
| Provider Name | Angel L Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164430658 PECOS PAC ID: 1153327788 Enrollment ID: I20061004000583 |
| Provider Name | David H Freeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205894417 PECOS PAC ID: 4688672850 Enrollment ID: I20061122000299 |
| Provider Name | Harvey H Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689672248 PECOS PAC ID: 1658326772 Enrollment ID: I20061129000122 |
| Provider Name | Thomas E Shields |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1306955471 PECOS PAC ID: 2860491370 Enrollment ID: I20061211000535 |
| Provider Name | Cynthia C Chapman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689698722 PECOS PAC ID: 1254332901 Enrollment ID: I20070123000270 |
| Provider Name | Jennifer S Gannon |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1194721241 PECOS PAC ID: 7416958129 Enrollment ID: I20070124000140 |
| Provider Name | Karen A Nielson-salois |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013078336 PECOS PAC ID: 8921009242 Enrollment ID: I20070129000509 |
| Provider Name | Barbara S Cohn |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1003918384 PECOS PAC ID: 9335246438 Enrollment ID: I20070524000529 |
| Provider Name | Shannelle S Rico |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023078623 PECOS PAC ID: 0648231373 Enrollment ID: I20071101000703 |
| Provider Name | Deinso A Gillis-harry |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1417012808 PECOS PAC ID: 5698796191 Enrollment ID: I20080107000776 |
| Provider Name | Mary A Gookin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104000827 PECOS PAC ID: 3476637331 Enrollment ID: I20080301000095 |
| Provider Name | Kurt S Gustavson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1225255086 PECOS PAC ID: 6305924754 Enrollment ID: I20080424000773 |
| Provider Name | Lynelle N Noisy Hawk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881894152 PECOS PAC ID: 8325127822 Enrollment ID: I20080508000803 |
| Provider Name | Jerry L Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053574772 PECOS PAC ID: 0042388969 Enrollment ID: I20081006000298 |
| Provider Name | Duane M Chase |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992844906 PECOS PAC ID: 7719045806 Enrollment ID: I20081017000486 |
| Provider Name | Richard H Olson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912076928 PECOS PAC ID: 3779526306 Enrollment ID: I20081211000040 |
| Provider Name | Patricia D Kuehl |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1649357195 PECOS PAC ID: 0749345049 Enrollment ID: I20090220000352 |
| Provider Name | Peter A De Schweinitz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427085711 PECOS PAC ID: 1951375088 Enrollment ID: I20090327000456 |
| Provider Name | Jennifer M Lachapell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396773594 PECOS PAC ID: 6305844481 Enrollment ID: I20090514000481 |
| Provider Name | Robert M Kirk |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1922045012 PECOS PAC ID: 2264333871 Enrollment ID: I20090709000458 |
| Provider Name | Neil A Sun Rhodes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184894727 PECOS PAC ID: 6709963606 Enrollment ID: I20090728000607 |
| Provider Name | Gregory M Smith |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1396758017 PECOS PAC ID: 6608920822 Enrollment ID: I20090821000258 |
| Provider Name | Bella M Gentry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154598746 PECOS PAC ID: 2163578295 Enrollment ID: I20090915000450 |
| Provider Name | Lori G Byron |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992731566 PECOS PAC ID: 2769538818 Enrollment ID: I20090915000602 |
| Provider Name | Erin E Neibauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760621544 PECOS PAC ID: 3375689508 Enrollment ID: I20091001000429 |
| Provider Name | Kristin A Yandora |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497922413 PECOS PAC ID: 0749352193 Enrollment ID: I20091008000653 |
| Provider Name | Deborah L Russell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447307830 PECOS PAC ID: 0941346555 Enrollment ID: I20091013000558 |
| Provider Name | Daniel H Franz |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1922057140 PECOS PAC ID: 4284689274 Enrollment ID: I20091113000090 |
| Provider Name | Joni D Renbarger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629238365 PECOS PAC ID: 1254470602 Enrollment ID: I20091125000251 |
| Provider Name | Jenaneta S Hampton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396817516 PECOS PAC ID: 2769546472 Enrollment ID: I20091202000233 |
| Provider Name | Jacqueline L Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548333206 PECOS PAC ID: 7113066929 Enrollment ID: I20091207000622 |
| Provider Name | Phillip K Rector |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952468043 PECOS PAC ID: 6204970239 Enrollment ID: I20100215000411 |
| Provider Name | Darlene M Wilcox |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730412867 PECOS PAC ID: 5496880890 Enrollment ID: I20100323000789 |
| Provider Name | Michael Durant Murphy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891812921 PECOS PAC ID: 2163559063 Enrollment ID: I20100426000225 |
| Provider Name | Mary A Schneider |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1568610491 PECOS PAC ID: 2365596236 Enrollment ID: I20100510000219 |
| Provider Name | Jeffrey E Smith |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1427009570 PECOS PAC ID: 7517978885 Enrollment ID: I20100615000858 |
| Provider Name | Brian A Molloy |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1760452791 PECOS PAC ID: 7810041829 Enrollment ID: I20100630000680 |
| Provider Name | Kerry T Nickou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811059249 PECOS PAC ID: 0042343394 Enrollment ID: I20100806000360 |
| Provider Name | Garth E Reber |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1417029950 PECOS PAC ID: 3476687690 Enrollment ID: I20100810000507 |
| Provider Name | Karen E Kajiwara Nelson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1548360381 PECOS PAC ID: 9436283413 Enrollment ID: I20100812000335 |
| Provider Name | Mark S Cardinal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508931981 PECOS PAC ID: 0547384604 Enrollment ID: I20100826000998 |
| Provider Name | Ethel L Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053437079 PECOS PAC ID: 3779607635 Enrollment ID: I20100830000054 |
| Provider Name | William A Calder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275605412 PECOS PAC ID: 1254455728 Enrollment ID: I20100907000202 |
| Provider Name | Kimberly R Donohue |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457548760 PECOS PAC ID: 5799800173 Enrollment ID: I20100909000540 |
| Provider Name | Nancy L King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104999242 PECOS PAC ID: 7012109457 Enrollment ID: I20101004001401 |
| Provider Name | Peter J Arosemena |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265532907 PECOS PAC ID: 1951593102 Enrollment ID: I20101007000154 |
| Provider Name | Connie M Sherer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851352736 PECOS PAC ID: 8820016975 Enrollment ID: I20101012000423 |
| Provider Name | Martha E Burton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497828768 PECOS PAC ID: 6901093343 Enrollment ID: I20101210000062 |
| Provider Name | Garold D Spire |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467528596 PECOS PAC ID: 5991992331 Enrollment ID: I20101210000071 |
| Provider Name | Steven B. Sonntag |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215005335 PECOS PAC ID: 0143127639 Enrollment ID: I20101221001071 |
| Provider Name | Mary C Desrosier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467672287 PECOS PAC ID: 8527247956 Enrollment ID: I20110131001011 |
| Provider Name | Kendall S Flint |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154504199 PECOS PAC ID: 4082677364 Enrollment ID: I20110224000556 |
| Provider Name | Luis E Millan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497068183 PECOS PAC ID: 2264619949 Enrollment ID: I20110606000594 |
| Provider Name | Hanan Fahmy |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1659387413 PECOS PAC ID: 0547274243 Enrollment ID: I20110615000491 |
| Provider Name | Kelly Jo Dalton |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1932365137 PECOS PAC ID: 2668650144 Enrollment ID: I20110705000296 |
| Provider Name | Joan A Tapper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285815720 PECOS PAC ID: 0840332821 Enrollment ID: I20110720000809 |
| Provider Name | Van Pho |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740437284 PECOS PAC ID: 1052580651 Enrollment ID: I20110817000214 |
| Provider Name | Rebecca S Uranga |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1558482026 PECOS PAC ID: 1658541826 Enrollment ID: I20110825000247 |
| Provider Name | Howard R. Knapp |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861413148 PECOS PAC ID: 0941203707 Enrollment ID: I20110908002325 |
| Provider Name | Robert P Drewelow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073760393 PECOS PAC ID: 3375714363 Enrollment ID: I20110923000162 |
| Provider Name | Robert S Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538108204 PECOS PAC ID: 3173782950 Enrollment ID: I20120314000546 |
| Provider Name | Michael F Ksycki |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1194975334 PECOS PAC ID: 3971665530 Enrollment ID: I20120314000686 |
| Provider Name | Cheryl C Portwood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639246044 PECOS PAC ID: 0840394219 Enrollment ID: I20120402000260 |
| Provider Name | Raquel Jaatoul |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619056959 PECOS PAC ID: 3274554050 Enrollment ID: I20120425000797 |
| Provider Name | Jeffrey Lynn Schaffer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124131255 PECOS PAC ID: 8921902768 Enrollment ID: I20120611000061 |
| Provider Name | Samuel C Covington |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063694461 PECOS PAC ID: 8022193267 Enrollment ID: I20120813000325 |
| Provider Name | Robert H Martin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316954860 PECOS PAC ID: 8022008143 Enrollment ID: I20120816000632 |
| Provider Name | Michael J Mccormick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710069737 PECOS PAC ID: 7214184837 Enrollment ID: I20120904000186 |
| Provider Name | Lynda-marie S George |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962471847 PECOS PAC ID: 5890730063 Enrollment ID: I20120924000435 |
| Provider Name | Robert G Apgar |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1093794398 PECOS PAC ID: 2163499013 Enrollment ID: I20130211000037 |
| Provider Name | Carmel F Bonnaig |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558331272 PECOS PAC ID: 1456337229 Enrollment ID: I20130212000156 |
| Provider Name | Charles J Mcmullin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215049788 PECOS PAC ID: 9032136270 Enrollment ID: I20130320000259 |
| Provider Name | Joshua M Timock |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841386240 PECOS PAC ID: 6901807478 Enrollment ID: I20130502000278 |
| Provider Name | Thomas E Martin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093847915 PECOS PAC ID: 4284874447 Enrollment ID: I20130711000242 |
| Provider Name | Karen L Zoller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730357377 PECOS PAC ID: 8022195361 Enrollment ID: I20130712000607 |
| Provider Name | Charles J Thurston |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568576007 PECOS PAC ID: 6103816210 Enrollment ID: I20130801000838 |
| Provider Name | Aster Berhane |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528276003 PECOS PAC ID: 4981838208 Enrollment ID: I20130927000546 |
| Provider Name | Jon A Ossen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174537872 PECOS PAC ID: 5991719932 Enrollment ID: I20131104000134 |
| Provider Name | Linda A Mclaughlin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659495661 PECOS PAC ID: 1052404258 Enrollment ID: I20131114001594 |
| Provider Name | Kenneth A Freeman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750714754 PECOS PAC ID: 4284861220 Enrollment ID: I20131218001028 |
| Provider Name | Jose R Lopez |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1922178128 PECOS PAC ID: 6901035062 Enrollment ID: I20140212001469 |
| Provider Name | Jonathan M Gilbert |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033140686 PECOS PAC ID: 6305935511 Enrollment ID: I20140225000330 |
| Provider Name | Luz E Rodriguez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649332578 PECOS PAC ID: 0143450254 Enrollment ID: I20140310001971 |
| Provider Name | Alan C Ostby |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912019951 PECOS PAC ID: 0749312734 Enrollment ID: I20140311001198 |
| Provider Name | Melanie A Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083948889 PECOS PAC ID: 0840479879 Enrollment ID: I20140327000941 |
| Provider Name | Wiley Wilson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1083686430 PECOS PAC ID: 7810046257 Enrollment ID: I20140409001075 |
| Provider Name | Navtejpal Singh Kahlon |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1750715777 PECOS PAC ID: 1355577958 Enrollment ID: I20140505001436 |
| Provider Name | Kristy R Rodriguez |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1407271117 PECOS PAC ID: 3375776776 Enrollment ID: I20140509002034 |
| Provider Name | Tina M Berg |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1407906381 PECOS PAC ID: 7012982077 Enrollment ID: I20140718001512 |
| Provider Name | Travis J Townsend |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568787554 PECOS PAC ID: 0547487092 Enrollment ID: I20140807001039 |
| Provider Name | Thomas Riney |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457341307 PECOS PAC ID: 6901863307 Enrollment ID: I20140825002357 |
| Provider Name | Laurel Matthews |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801960471 PECOS PAC ID: 0840298766 Enrollment ID: I20140915000784 |
| Provider Name | Lisa S Sun Rhodes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932495686 PECOS PAC ID: 9234376096 Enrollment ID: I20140930002298 |
| Provider Name | Tyler Evans |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912227125 PECOS PAC ID: 9335311059 Enrollment ID: I20140930002925 |
| Provider Name | Wendy S Killham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114336351 PECOS PAC ID: 3870713001 Enrollment ID: I20141009002051 |
| Provider Name | Nipa H Sinh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073740288 PECOS PAC ID: 9335360858 Enrollment ID: I20141027002408 |
| Provider Name | Linda M Smith |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1770843252 PECOS PAC ID: 5294956470 Enrollment ID: I20141103000480 |
| Provider Name | Gabriele L Knierim |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366420499 PECOS PAC ID: 7012957004 Enrollment ID: I20141112000939 |
| Provider Name | Ali Mastali |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821401258 PECOS PAC ID: 2567688179 Enrollment ID: I20141119001894 |
| Provider Name | Pauline J King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700127743 PECOS PAC ID: 3173760220 Enrollment ID: I20141125000332 |
| Provider Name | Richard P Nery |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1114101789 PECOS PAC ID: 5193047009 Enrollment ID: I20141204000315 |
| Provider Name | Kenneth T Wallenfelsz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457649998 PECOS PAC ID: 0749433506 Enrollment ID: I20141230000263 |
| Provider Name | Michael R Jarvis |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1902845936 PECOS PAC ID: 0042283582 Enrollment ID: I20141230002098 |
| Provider Name | Lawrence J Zazzo |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1013049758 PECOS PAC ID: 0446382204 Enrollment ID: I20141231001434 |
| Provider Name | Sarah Malli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861744252 PECOS PAC ID: 8426277757 Enrollment ID: I20150107001691 |
| Provider Name | Timothy L Honderick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629314307 PECOS PAC ID: 0244273407 Enrollment ID: I20150226000517 |
| Provider Name | Ragavan Mahadevan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194955542 PECOS PAC ID: 8820315617 Enrollment ID: I20150316000190 |
| Provider Name | Jason K Kane |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1639459068 PECOS PAC ID: 9335366285 Enrollment ID: I20150402000595 |
| Provider Name | Kenneth H Susman |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1891720645 PECOS PAC ID: 0446140784 Enrollment ID: I20150421000138 |
| Provider Name | Marie R Greenspan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184616765 PECOS PAC ID: 1850561929 Enrollment ID: I20150427000473 |
| Provider Name | Philip E Stein |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1669536918 PECOS PAC ID: 3577590223 Enrollment ID: I20150428000464 |
| Provider Name | Susan G Maier |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1194068262 PECOS PAC ID: 0547582645 Enrollment ID: I20150428000662 |
| Provider Name | Janet M Thurston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235211962 PECOS PAC ID: 8628126091 Enrollment ID: I20150430000583 |
| Provider Name | Tony Underwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558759530 PECOS PAC ID: 5496076440 Enrollment ID: I20150603001162 |
| Provider Name | Jae Dell M Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215361787 PECOS PAC ID: 8123349610 Enrollment ID: I20150609002469 |
| Provider Name | Earl S Kimbell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437189305 PECOS PAC ID: 2365491230 Enrollment ID: I20150612002306 |
| Provider Name | Scott L Diering |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083633465 PECOS PAC ID: 7719936988 Enrollment ID: I20150624002615 |
| Provider Name | Kyle Debenham |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225067325 PECOS PAC ID: 1759341183 Enrollment ID: I20150701000753 |
| Provider Name | Armando Sanchez Burgos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184875296 PECOS PAC ID: 7618157678 Enrollment ID: I20150811003986 |
| Provider Name | Earle M Taylor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487607578 PECOS PAC ID: 8921001983 Enrollment ID: I20150827001584 |
| Provider Name | Marion E Rudek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013275734 PECOS PAC ID: 6305153065 Enrollment ID: I20150914002344 |
| Provider Name | Justin Sean Ribault |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306070966 PECOS PAC ID: 5092022269 Enrollment ID: I20150921001835 |
| Provider Name | Pierrette Toussaint |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1396159240 PECOS PAC ID: 0749598852 Enrollment ID: I20151008002276 |
| Provider Name | Wally Jean |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1346654167 PECOS PAC ID: 4688982721 Enrollment ID: I20151009000241 |
| Provider Name | Janet L Erickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730348327 PECOS PAC ID: 7719296193 Enrollment ID: I20151026002367 |
| Provider Name | Gloria Intriago |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1316371347 PECOS PAC ID: 5597909994 Enrollment ID: I20151027001689 |
| Provider Name | Anthony P Tranchita |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437139847 PECOS PAC ID: 1052621208 Enrollment ID: I20151030001606 |
| Provider Name | Vishal Jariwala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316209190 PECOS PAC ID: 6608184312 Enrollment ID: I20151107000004 |
| Provider Name | Urooj Saeed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710272588 PECOS PAC ID: 2163732801 Enrollment ID: I20151109000254 |
| Provider Name | Libbi Martino |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1093896300 PECOS PAC ID: 4587683628 Enrollment ID: I20151113000909 |
| Provider Name | Emily Dorr Mathiak |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1790047819 PECOS PAC ID: 4688820723 Enrollment ID: I20151202002667 |
| Provider Name | Catherine G Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609280833 PECOS PAC ID: 0941521124 Enrollment ID: I20151211000697 |
| Provider Name | Allison B Taranto |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1699171009 PECOS PAC ID: 7618277336 Enrollment ID: I20151217001214 |
| Provider Name | Toni Lynn Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801196191 PECOS PAC ID: 1456384767 Enrollment ID: I20151222002047 |
| Provider Name | Dawn Underwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083002729 PECOS PAC ID: 3072814748 Enrollment ID: I20151222002182 |
| Provider Name | Basem Z Fanous |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1336173871 PECOS PAC ID: 9638194442 Enrollment ID: I20160108000378 |
| Provider Name | Rajesh A Persaud |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023384179 PECOS PAC ID: 3375861057 Enrollment ID: I20160111002659 |
| Provider Name | Adnan Habib |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699088864 PECOS PAC ID: 2769618172 Enrollment ID: I20160218002287 |
| Provider Name | Brian E Reynolds |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407810963 PECOS PAC ID: 6406936970 Enrollment ID: I20160223001453 |
| Provider Name | Thu K Tran |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1225479918 PECOS PAC ID: 1355646761 Enrollment ID: I20160223001974 |
| Provider Name | Luis A Rosa |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063608958 PECOS PAC ID: 4981882354 Enrollment ID: I20160315002241 |
| Provider Name | Katherine Garnett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033471842 PECOS PAC ID: 5799081832 Enrollment ID: I20160315002700 |
| Provider Name | Lindsey A Gauderer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477936961 PECOS PAC ID: 2769788777 Enrollment ID: I20160316001963 |
| Provider Name | Peter Erigoyen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013997667 PECOS PAC ID: 8527037167 Enrollment ID: I20160419000568 |
| Provider Name | Wesley Lewis |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1386873180 PECOS PAC ID: 3577602697 Enrollment ID: I20160513000458 |
| Provider Name | Mary E Pauzauskie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184675399 PECOS PAC ID: 6305899600 Enrollment ID: I20160707001004 |
| Provider Name | Pedro B Guzman Pisfil |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215200985 PECOS PAC ID: 6103088331 Enrollment ID: I20161011001314 |
| Provider Name | Shelley P Rickett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437510807 PECOS PAC ID: 2961628326 Enrollment ID: I20161203000128 |
| Provider Name | Melissa S Kuntz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831565423 PECOS PAC ID: 6103127584 Enrollment ID: I20161209000380 |
| Provider Name | Karen Saling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154377422 PECOS PAC ID: 8426074683 Enrollment ID: I20170113000240 |
| Provider Name | Elisadel Figueroa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154725273 PECOS PAC ID: 8325321367 Enrollment ID: I20170216002245 |
| Provider Name | Shankar P Bhat |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1639156037 PECOS PAC ID: 8628053691 Enrollment ID: I20170316001165 |
| Provider Name | Melissa A Kendall |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1912374299 PECOS PAC ID: 2567747025 Enrollment ID: I20170323001937 |
| Provider Name | Stacy L Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740510528 PECOS PAC ID: 6204073737 Enrollment ID: I20170412001763 |
| Provider Name | Lori Flis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154457117 PECOS PAC ID: 1759464548 Enrollment ID: I20170419002641 |
| Provider Name | Richard J Donlick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528238987 PECOS PAC ID: 4486817186 Enrollment ID: I20170420002029 |
| Provider Name | Marianna Holland |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1356712822 PECOS PAC ID: 8729397567 Enrollment ID: I20170803003010 |
| Provider Name | Chantielle Ann Blackwell |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1518364058 PECOS PAC ID: 6608183876 Enrollment ID: I20170807000305 |
| Provider Name | Alexander Figueroa Madera |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760890123 PECOS PAC ID: 1557682200 Enrollment ID: I20171130000333 |
| Provider Name | Thuy-trang T Ngo |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1831327444 PECOS PAC ID: 5698990075 Enrollment ID: I20180109002084 |
| Provider Name | Georgia Matt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386952190 PECOS PAC ID: 5991064099 Enrollment ID: I20180118000787 |
| Provider Name | Pierre G Latortue |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1962926980 PECOS PAC ID: 7911266754 Enrollment ID: I20180124000308 |
| Provider Name | Margaret Marla Kirlin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194122820 PECOS PAC ID: 8527382209 Enrollment ID: I20180201000442 |
| Provider Name | Anh T Pham |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1609325711 PECOS PAC ID: 5193086106 Enrollment ID: I20180307001194 |
| Provider Name | Janell L Simpkins |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619989605 PECOS PAC ID: 6204025661 Enrollment ID: I20180308000855 |
| Provider Name | Robert L Holman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1225083587 PECOS PAC ID: 7517919095 Enrollment ID: I20180308002306 |
| Provider Name | Jon Sands Tyrell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1033129945 PECOS PAC ID: 2264565449 Enrollment ID: I20180402000500 |
| Provider Name | Jin Ping Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770981839 PECOS PAC ID: 8729343702 Enrollment ID: I20180522000394 |
| Provider Name | Queenta E Teko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114451937 PECOS PAC ID: 5698022135 Enrollment ID: I20180716001637 |
| Provider Name | Jill E Long |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1407831902 PECOS PAC ID: 2365766250 Enrollment ID: I20180730000852 |
| Provider Name | Nuanphan S Poole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801393707 PECOS PAC ID: 4385993591 Enrollment ID: I20180822000261 |
| Provider Name | Farah Lazarre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699264663 PECOS PAC ID: 0446501332 Enrollment ID: I20180914001212 |
| Provider Name | Caroline Fichter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124534235 PECOS PAC ID: 9537410477 Enrollment ID: I20180917000977 |
| Provider Name | Alfonso Torres Garcia |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1992714190 PECOS PAC ID: 1850549692 Enrollment ID: I20180917001792 |
| Provider Name | Michelle Ligonde-merisio |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1023109931 PECOS PAC ID: 5799885588 Enrollment ID: I20180920002188 |
| Provider Name | Mark Krich |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144238767 PECOS PAC ID: 4789585985 Enrollment ID: I20180924000921 |
| Provider Name | Odinaka A Nwankwo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437542677 PECOS PAC ID: 0244581619 Enrollment ID: I20180924003018 |
| Provider Name | Charmaine G Etienne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114461902 PECOS PAC ID: 0648521039 Enrollment ID: I20180925000213 |
| Provider Name | Erin R Gockel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548740368 PECOS PAC ID: 2466703871 Enrollment ID: I20180925001201 |
| Provider Name | Pablo A Serrano-lopez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1730598004 PECOS PAC ID: 8022316306 Enrollment ID: I20181030000370 |
| Provider Name | Ashley Akhter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134570245 PECOS PAC ID: 7315219144 Enrollment ID: I20181108001580 |
| Provider Name | Marjorie P Turner |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447565635 PECOS PAC ID: 8123372695 Enrollment ID: I20181120000383 |
| Provider Name | Sandra Wilson |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1235348962 PECOS PAC ID: 4587989033 Enrollment ID: I20181130000481 |
| Provider Name | Kim Wilde |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891744140 PECOS PAC ID: 3375686173 Enrollment ID: I20190123000471 |
| Provider Name | Nicholas Patrick Sheridan |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1144209917 PECOS PAC ID: 4880931922 Enrollment ID: I20190128000490 |
| Provider Name | Delight J Griswold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720097017 PECOS PAC ID: 6608895214 Enrollment ID: I20190128000742 |
| Provider Name | Pauline Powers-peprah |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1033553185 PECOS PAC ID: 7113160599 Enrollment ID: I20190130001440 |
| Provider Name | Kyle Baker |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780171298 PECOS PAC ID: 1951649045 Enrollment ID: I20190215000123 |
| Provider Name | Craig Alan Clark |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1427222843 PECOS PAC ID: 8628316528 Enrollment ID: I20190220000491 |
| Provider Name | Jeremy C Norton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205260502 PECOS PAC ID: 1456694017 Enrollment ID: I20190522001458 |
| Provider Name | William P Lunger |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1285073684 PECOS PAC ID: 4183957418 Enrollment ID: I20190531000719 |
| Provider Name | Megan R Wexler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093258808 PECOS PAC ID: 9830422930 Enrollment ID: I20190604002981 |
| Provider Name | Lynn Baru |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1972529055 PECOS PAC ID: 5890798185 Enrollment ID: I20190626002927 |
| Provider Name | Warren D Everett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487600318 PECOS PAC ID: 0446239206 Enrollment ID: I20190718000865 |
| Provider Name | Marc D Mclaughlin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164726766 PECOS PAC ID: 2860671666 Enrollment ID: I20190923001237 |
| Provider Name | Eric S Sawyers |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1780686188 PECOS PAC ID: 3072750967 Enrollment ID: I20191216000205 |
| Provider Name | Kelly R Mcelroy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922000686 PECOS PAC ID: 2264328178 Enrollment ID: I20191231000448 |
| Provider Name | Jessica M Domire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790293116 PECOS PAC ID: 3678802865 Enrollment ID: I20200103000838 |
| Provider Name | Analee Marie Lee Palou Miranda |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275880965 PECOS PAC ID: 7113351917 Enrollment ID: I20200103001092 |
| Provider Name | Stacy L Newbern |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386020352 PECOS PAC ID: 9436499910 Enrollment ID: I20200107000547 |
| Provider Name | Ming T Lin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427088947 PECOS PAC ID: 9133186125 Enrollment ID: I20200124000272 |
| Provider Name | Kara Elizabeth Sprangers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699329243 PECOS PAC ID: 4587090915 Enrollment ID: I20200204000590 |
| Provider Name | Raichell Lynn Dorland-roan |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1568841658 PECOS PAC ID: 4880915735 Enrollment ID: I20200303000184 |
| Provider Name | Matthew T Graf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215374905 PECOS PAC ID: 2163743337 Enrollment ID: I20200303000781 |
| Provider Name | Louisa Benson Mook |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710229810 PECOS PAC ID: 6901126036 Enrollment ID: I20200303002015 |
| Provider Name | Sarah E Hardwick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053973198 PECOS PAC ID: 3173951951 Enrollment ID: I20200309001749 |
| Provider Name | Jun He |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376704213 PECOS PAC ID: 1557537412 Enrollment ID: I20200323000401 |
| Provider Name | Himabindu Borra |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1710936596 PECOS PAC ID: 4981848983 Enrollment ID: I20200327002098 |
| Provider Name | Nisha J Manek |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1437139151 PECOS PAC ID: 4486798097 Enrollment ID: I20200401001340 |
| Provider Name | Janet L Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205137270 PECOS PAC ID: 1850587254 Enrollment ID: I20200406002566 |
| Provider Name | Adam Peterson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033539937 PECOS PAC ID: 9436378734 Enrollment ID: I20200406003274 |
| Provider Name | Deborah L Elliott Pearson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881616639 PECOS PAC ID: 6800959248 Enrollment ID: I20200408000036 |
| Provider Name | Kenneth J Eckstein |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174640239 PECOS PAC ID: 8224015409 Enrollment ID: I20200417001585 |
| Provider Name | Mary De Leon |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1184692006 PECOS PAC ID: 0345224663 Enrollment ID: I20200421000623 |
| Provider Name | Margarita A Wilkes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245524610 PECOS PAC ID: 4880983964 Enrollment ID: I20200512002974 |
| Provider Name | Wanda Shao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407292857 PECOS PAC ID: 5092084673 Enrollment ID: I20200513000610 |
| Provider Name | Kanan D Maniar |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1366534042 PECOS PAC ID: 7911897830 Enrollment ID: I20200521000515 |
| Provider Name | Alexis Gadwah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891263877 PECOS PAC ID: 7113349820 Enrollment ID: I20200626000003 |
| Provider Name | Vikram S Shankar |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821443276 PECOS PAC ID: 5294154894 Enrollment ID: I20201001000468 |
| Provider Name | Meeri Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467081513 PECOS PAC ID: 9739590068 Enrollment ID: I20201118000100 |
| Provider Name | Sumita Mehta |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1568768828 PECOS PAC ID: 8426234493 Enrollment ID: I20201222000313 |
| Provider Name | John A Gnassi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1629066105 PECOS PAC ID: 2365488715 Enrollment ID: I20210119001789 |
| Provider Name | Mitchell J Relf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245886746 PECOS PAC ID: 0446664106 Enrollment ID: I20210121000799 |
| Provider Name | Kenna Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073167953 PECOS PAC ID: 3173937844 Enrollment ID: I20210121001245 |
| Provider Name | Anders Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790393825 PECOS PAC ID: 6608280383 Enrollment ID: I20210121001365 |
| Provider Name | Jacklyn R Genzlinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548733116 PECOS PAC ID: 0648607978 Enrollment ID: I20210202001205 |
| Provider Name | Collin Block |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982231510 PECOS PAC ID: 2567886575 Enrollment ID: I20210202002537 |
| Provider Name | Juan C Cordero |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831506476 PECOS PAC ID: 2567879190 Enrollment ID: I20210329000412 |
| Provider Name | Paul A Jokisch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821754136 PECOS PAC ID: 9830582766 Enrollment ID: I20220216002604 |
| Provider Name | Jennifer M Macdonald |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942695507 PECOS PAC ID: 3274841168 Enrollment ID: I20220224000045 |
| Provider Name | Adrienne Highhouse |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609459106 PECOS PAC ID: 0941694905 Enrollment ID: I20220308002267 |
| Provider Name | Sydney Tomlinson |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1154909596 PECOS PAC ID: 6901291814 Enrollment ID: I20220311000082 |
| Provider Name | Merrill T Miller |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1932245248 PECOS PAC ID: 6507895034 Enrollment ID: I20220315001358 |
| Provider Name | Richard Esham |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1801221601 PECOS PAC ID: 9638472459 Enrollment ID: I20220317000143 |
| Provider Name | Natalie Wood |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104280619 PECOS PAC ID: 2466782297 Enrollment ID: I20220317000342 |
| Provider Name | Nicholas J Lyons |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1619105509 PECOS PAC ID: 1456407592 Enrollment ID: I20220317002147 |
| Provider Name | Charles Lambiotte |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609969534 PECOS PAC ID: 8325933286 Enrollment ID: I20220325001101 |
| Provider Name | Nicole C Gore |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1710208079 PECOS PAC ID: 9537341169 Enrollment ID: I20220329000598 |
| Provider Name | Deborah Obryan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033151824 PECOS PAC ID: 7012067002 Enrollment ID: I20220330001196 |
| Provider Name | Jeffrey Yellow Owl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629436639 PECOS PAC ID: 2961898945 Enrollment ID: I20220330001901 |
| Provider Name | Sara Lynn Bonanini |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801275037 PECOS PAC ID: 1759777634 Enrollment ID: I20220331002604 |
| Provider Name | Zachary Zemore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477908234 PECOS PAC ID: 4082908447 Enrollment ID: I20220404002706 |
| Provider Name | Cody Grace |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346735834 PECOS PAC ID: 4789935685 Enrollment ID: I20220404002783 |
| Provider Name | Tomasz Olejnik |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780180695 PECOS PAC ID: 0244586154 Enrollment ID: I20220408000509 |
| Provider Name | Amanda Marie Sipp |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1730442765 PECOS PAC ID: 0143563163 Enrollment ID: I20220414000720 |
| Provider Name | Scott L Stephens |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1528227212 PECOS PAC ID: 2860560265 Enrollment ID: I20220418000395 |
| Provider Name | Amy M Fleck |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1598712515 PECOS PAC ID: 4385646694 Enrollment ID: I20220419000181 |
| Provider Name | Lindsay Carlson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245692524 PECOS PAC ID: 6406140276 Enrollment ID: I20220420001264 |
| Provider Name | Kim Rolfsen |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1346794278 PECOS PAC ID: 6709173156 Enrollment ID: I20220429000216 |
| Provider Name | Andrew J Langfield |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1952835092 PECOS PAC ID: 2466879358 Enrollment ID: I20220503000127 |
| Provider Name | Catherine Kennedy |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1235676479 PECOS PAC ID: 7113304361 Enrollment ID: I20220510000903 |
| Provider Name | Robert Eugene Roe |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1528173630 PECOS PAC ID: 2264588581 Enrollment ID: I20220510002154 |
| Provider Name | Elena K Phoutrides |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093149429 PECOS PAC ID: 2466877758 Enrollment ID: I20220517000025 |
| Provider Name | Michelle Daya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790120343 PECOS PAC ID: 4981820123 Enrollment ID: I20220520000683 |
| Provider Name | Michelle G Merchant |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285052134 PECOS PAC ID: 1456634823 Enrollment ID: I20220526000086 |
| Provider Name | Sandra Bailey |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1396772067 PECOS PAC ID: 4880697499 Enrollment ID: I20220526000445 |
| Provider Name | Benjamin Todd Eastham |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1215223029 PECOS PAC ID: 8022322361 Enrollment ID: I20220630001302 |
| Provider Name | James L Kuhn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1033775176 PECOS PAC ID: 2769864388 Enrollment ID: I20220728003648 |
| Provider Name | Michael D Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215956768 PECOS PAC ID: 3971674862 Enrollment ID: I20220805001710 |
| Provider Name | Lisa M Scheresky Oneil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821585209 PECOS PAC ID: 4284016155 Enrollment ID: I20220809002879 |
| Provider Name | Tiffani F Methvien |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1093368854 PECOS PAC ID: 7012245210 Enrollment ID: I20220812000385 |
| Provider Name | James M Cowan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598207862 PECOS PAC ID: 8729499561 Enrollment ID: I20220812001587 |
| Provider Name | Amy A Pittman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972567600 PECOS PAC ID: 8628013380 Enrollment ID: I20220906000729 |
| Provider Name | David Charles Randall |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1952842742 PECOS PAC ID: 3476899519 Enrollment ID: I20221013003382 |
| Provider Name | Lawrence Kent Harrington |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1689662454 PECOS PAC ID: 1951770189 Enrollment ID: I20221212000286 |
| Provider Name | Hannah M Huddleston |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1023285335 PECOS PAC ID: 1951479773 Enrollment ID: I20221221002494 |
| Provider Name | Daniel David Metzger |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1124485453 PECOS PAC ID: 8820383508 Enrollment ID: I20221223000195 |
| Provider Name | Frederick Chu |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316478167 PECOS PAC ID: 1355769803 Enrollment ID: I20221228002412 |
| Provider Name | Clayton J Overton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598712135 PECOS PAC ID: 2860485810 Enrollment ID: I20230114000195 |
| Provider Name | Mintoria Stockton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316561178 PECOS PAC ID: 6002225927 Enrollment ID: I20230119000264 |
| Provider Name | Angela O Waller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194774190 PECOS PAC ID: 6406868892 Enrollment ID: I20230209003185 |
| Provider Name | Todd J Crockett |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1457560815 PECOS PAC ID: 4082934781 Enrollment ID: I20230214003414 |
| Provider Name | Arthur F Wang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548498751 PECOS PAC ID: 0244496966 Enrollment ID: I20230215000885 |
| Provider Name | Richard David Rush |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1568483303 PECOS PAC ID: 2365769908 Enrollment ID: I20230221000972 |
| Provider Name | Sheila Middagh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164076741 PECOS PAC ID: 7618206756 Enrollment ID: I20230221001861 |
| Provider Name | Maria Kofas |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1154860013 PECOS PAC ID: 4688048341 Enrollment ID: I20230320001363 |
| Provider Name | Danielle Sue Raveling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447896881 PECOS PAC ID: 7618341009 Enrollment ID: I20230327001676 |
| Provider Name | Derek V Chan |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1932488574 PECOS PAC ID: 9032346200 Enrollment ID: I20230329000461 |
| Provider Name | Daniel Junco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043711864 PECOS PAC ID: 4082016100 Enrollment ID: I20230330001924 |
| Provider Name | Kobina Wilmot |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1356667505 PECOS PAC ID: 6507131133 Enrollment ID: I20230417000512 |
| Provider Name | Alyssa Hartman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215571146 PECOS PAC ID: 1355762675 Enrollment ID: I20230428000245 |
| Provider Name | Kelly Donnelly Mueller |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1932369923 PECOS PAC ID: 3375778723 Enrollment ID: I20230506000104 |
| Provider Name | Kathy Robison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366195083 PECOS PAC ID: 4082073432 Enrollment ID: I20230705000010 |
| Provider Name | Theodore C Weatherwax |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144882879 PECOS PAC ID: 3577894096 Enrollment ID: I20230823001878 |
| Provider Name | Sosena Kebede |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790780195 PECOS PAC ID: 5991843914 Enrollment ID: I20230907000969 |
| Provider Name | Karen Kennedy |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932175734 PECOS PAC ID: 3577501188 Enrollment ID: I20230919002868 |
| Provider Name | Kate T. Brizzi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1659664373 PECOS PAC ID: 7517129208 Enrollment ID: I20231007000658 |
| Provider Name | Amy P Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912169442 PECOS PAC ID: 1557518552 Enrollment ID: I20231009000299 |
| Provider Name | Joseph Ciano |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871944843 PECOS PAC ID: 7113252214 Enrollment ID: I20231021000068 |
| Provider Name | David D Beversluis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326363789 PECOS PAC ID: 3476710252 Enrollment ID: I20231104000054 |
| Provider Name | Wesley A Johnson |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1467867895 PECOS PAC ID: 9931495090 Enrollment ID: I20231106001374 |
| Provider Name | Steven Bachini |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720392210 PECOS PAC ID: 5597112037 Enrollment ID: I20231106001811 |
| Provider Name | Kevin Jenkins |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164783452 PECOS PAC ID: 6507175684 Enrollment ID: I20231108000297 |
| Provider Name | Jeffrey S Kennedy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063450369 PECOS PAC ID: 2466606850 Enrollment ID: I20231108002638 |
| Provider Name | Tiffany Stensvad |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1770034472 PECOS PAC ID: 0547549529 Enrollment ID: I20231115000106 |
| Provider Name | Nathaniel Rieb |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1508068834 PECOS PAC ID: 9234324179 Enrollment ID: I20231204001705 |
| Provider Name | Nadia Boulghassoul-pietrzykowska |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1346401528 PECOS PAC ID: 8224296157 Enrollment ID: I20231206000639 |
| Provider Name | Jose Artemio Cumba Quiles |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1760717631 PECOS PAC ID: 0547505679 Enrollment ID: I20231211000339 |
| Provider Name | Barbara Lee |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1306958566 PECOS PAC ID: 7214095231 Enrollment ID: I20231212000101 |
| Provider Name | Abraham Santana Rodriguez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841609351 PECOS PAC ID: 3577869718 Enrollment ID: I20231214001460 |
| Provider Name | Stephen Noe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881605368 PECOS PAC ID: 1052585809 Enrollment ID: I20240109000351 |
| Provider Name | Oleg V Sinyavskiy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316177157 PECOS PAC ID: 6901038298 Enrollment ID: I20240110004687 |
| Provider Name | Jennifer Rosanna Hill |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1063545333 PECOS PAC ID: 8921451642 Enrollment ID: I20240130001430 |
| Provider Name | David Evan Mccracken |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1013327618 PECOS PAC ID: 6406299635 Enrollment ID: I20240205003342 |
| Provider Name | Leila Abidi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093449902 PECOS PAC ID: 5890138721 Enrollment ID: I20240208000560 |
| Provider Name | Julia Blanks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497481576 PECOS PAC ID: 1254774896 Enrollment ID: I20240209003391 |
| Provider Name | Robert Eric Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306037445 PECOS PAC ID: 5395145288 Enrollment ID: I20240212002020 |
| Provider Name | Eugene R. Aquino |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952663122 PECOS PAC ID: 6800041104 Enrollment ID: I20240212002346 |
| Provider Name | Jimmy Gray |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437191699 PECOS PAC ID: 6204893480 Enrollment ID: I20240305002652 |
| Provider Name | Chelsae L May |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1174144810 PECOS PAC ID: 4284046830 Enrollment ID: I20240305002744 |
Riverside Family Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 209 H St East, Poplar, MT 59255 Phone: 406-768-5171 Fax: 406-768-6161 |