| Abrazo Medical Group | |
|
1325 N Litchfield Rd Ste 125 Goodyear AZ 85395-1215 | |
| (623) 242-1231 | |
| (623) 242-1232 |
| Full Name | Abrazo Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 1325 N Litchfield Rd Ste 125, Goodyear, Arizona |
| Authorized Official Name and Position | Brian Rasmus (VP, CFO TPR) |
| Authorized Official Contact | 4698932532 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abrazo Medical Group Po Box 18892 Belfast ME 04915-4083 Ph: (888) 402-7256 | Abrazo Medical Group 1325 N Litchfield Rd Ste 125 Goodyear AZ 85395-1215 Ph: (623) 242-1231 |
| NPI Number | 1912979964 |
|---|---|
| Provider Enumeration Date | 02/03/2006 |
| Last Update Date | 09/23/2020 |
| Certification Date | 09/23/2020 |
| Medicare PECOS PAC ID | 4486566726 |
|---|---|
| Medicare Enrollment ID | O20031104000523 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912979964 | NPI | - | NPPES |
| Provider Name | Jeffrey a Copoloff |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1164461802 PECOS PAC ID: 2163335365 Enrollment ID: I20031112000281 |
| Provider Name | Amilee S Ning |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1699852053 PECOS PAC ID: 0547169377 Enrollment ID: I20031231000256 |
| Provider Name | Jason J Cool |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700886512 PECOS PAC ID: 6305747338 Enrollment ID: I20040114000256 |
| Provider Name | Billy J Evans |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114942422 PECOS PAC ID: 7911809140 Enrollment ID: I20040217000861 |
| Provider Name | Peter C Maki |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1306886775 PECOS PAC ID: 6608780523 Enrollment ID: I20040301001128 |
| Provider Name | Kevin Anthony Onan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1821080821 PECOS PAC ID: 9436046844 Enrollment ID: I20040301001167 |
| Provider Name | Charles Matlin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1023074945 PECOS PAC ID: 3173413564 Enrollment ID: I20040318001041 |
| Provider Name | Brian W Zernich |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902878895 PECOS PAC ID: 9931091253 Enrollment ID: I20040329001820 |
| Provider Name | Madhavagopal V Cherukuri |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1104860337 PECOS PAC ID: 1254324577 Enrollment ID: I20040405000374 |
| Provider Name | Joseph Hessel |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1306996228 PECOS PAC ID: 3173518974 Enrollment ID: I20040420000586 |
| Provider Name | Susan Pansing |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306816533 PECOS PAC ID: 6901892017 Enrollment ID: I20040423000460 |
| Provider Name | Vicente Diaz-gonzalez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1790745776 PECOS PAC ID: 1557353356 Enrollment ID: I20040513001258 |
| Provider Name | Chia How H Liu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851382899 PECOS PAC ID: 7911997101 Enrollment ID: I20040518000861 |
| Provider Name | Charles S Peterson |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1952302143 PECOS PAC ID: 2769473529 Enrollment ID: I20040520000546 |
| Provider Name | Kenneth R Hofstetter |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891753091 PECOS PAC ID: 0648252213 Enrollment ID: I20040614001301 |
| Provider Name | Erika L Vatsar Fail |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1770535742 PECOS PAC ID: 7416931886 Enrollment ID: I20040614001581 |
| Provider Name | Gary L Waslewski |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1902890031 PECOS PAC ID: 8325023211 Enrollment ID: I20040623001299 |
| Provider Name | Hack J Kim |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1588647044 PECOS PAC ID: 5698751766 Enrollment ID: I20040629000118 |
| Provider Name | Linda M Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396709192 PECOS PAC ID: 8426960709 Enrollment ID: I20040701000236 |
| Provider Name | Christine a Harter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639133903 PECOS PAC ID: 8729065289 Enrollment ID: I20040701001350 |
| Provider Name | Russell G Cohen |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1700887460 PECOS PAC ID: 3173501418 Enrollment ID: I20040712001459 |
| Provider Name | Timothy J Byrne |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1376585232 PECOS PAC ID: 9436063351 Enrollment ID: I20040713000111 |
| Provider Name | William a Arnold |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1720042591 PECOS PAC ID: 1850363789 Enrollment ID: I20040810001441 |
| Provider Name | Wade J Mcbride |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1164495917 PECOS PAC ID: 4284609512 Enrollment ID: I20040831000632 |
| Provider Name | Douglas B Mangan |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1831181999 PECOS PAC ID: 3274592753 Enrollment ID: I20041012000751 |
| Provider Name | Alex Westerband |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1295849099 PECOS PAC ID: 1456316876 Enrollment ID: I20041124000908 |
| Provider Name | Ananya Das |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1669457206 PECOS PAC ID: 9739145699 Enrollment ID: I20041202001021 |
| Provider Name | Akil Loli |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1962453803 PECOS PAC ID: 0749247872 Enrollment ID: I20041210000147 |
| Provider Name | Krishnaswami Vijayaraghavan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1376598151 PECOS PAC ID: 3971560343 Enrollment ID: I20041216001031 |
| Provider Name | Brenda L Hochuli |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1366435869 PECOS PAC ID: 4486602240 Enrollment ID: I20050107000688 |
| Provider Name | James R Hutchison |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1407805229 PECOS PAC ID: 1355399908 Enrollment ID: I20050110001091 |
| Provider Name | Douglas B Freedberg |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1497751283 PECOS PAC ID: 1951350925 Enrollment ID: I20050120000079 |
| Provider Name | John Vanderhoof |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1558471052 PECOS PAC ID: 5193774719 Enrollment ID: I20050120000558 |
| Provider Name | Lawrence a Kline |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1568463669 PECOS PAC ID: 9739131483 Enrollment ID: I20050210000820 |
| Provider Name | David C Zeman |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1902854276 PECOS PAC ID: 7911959622 Enrollment ID: I20050215000259 |
| Provider Name | Scott R Schalkle |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1770701492 PECOS PAC ID: 4880646819 Enrollment ID: I20050217000427 |
| Provider Name | Michelle R Kuhn |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770576241 PECOS PAC ID: 0648226449 Enrollment ID: I20050324000624 |
| Provider Name | Renzo M Cataldo |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1174526677 PECOS PAC ID: 6406894765 Enrollment ID: I20050419000255 |
| Provider Name | Marwan M Bahu |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1114920618 PECOS PAC ID: 0345288619 Enrollment ID: I20050419000337 |
| Provider Name | Warren Mark Breisblatt |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1063413177 PECOS PAC ID: 6709826142 Enrollment ID: I20050505000386 |
| Provider Name | Kirstine a Blackshear |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1841269313 PECOS PAC ID: 2860432556 Enrollment ID: I20050512000336 |
| Provider Name | Michael R Keller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821062183 PECOS PAC ID: 1658320999 Enrollment ID: I20050512000577 |
| Provider Name | Jennifer L Neil |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1518055177 PECOS PAC ID: 1456395375 Enrollment ID: I20050613000340 |
| Provider Name | Brent P Hansen |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1396716262 PECOS PAC ID: 8820061567 Enrollment ID: I20050613000936 |
| Provider Name | Nathan J Linstrom |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689848590 PECOS PAC ID: 7416993555 Enrollment ID: I20050629000722 |
| Provider Name | Penny a Vanpatten |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1871573808 PECOS PAC ID: 4385692391 Enrollment ID: I20050722000131 |
| Provider Name | Merick S Kirshner |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1831183870 PECOS PAC ID: 8729011713 Enrollment ID: I20050912000101 |
| Provider Name | Gregory S Spayde |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083608913 PECOS PAC ID: 9133152135 Enrollment ID: I20050912000149 |
| Provider Name | Matthew P Wilson |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1225018096 PECOS PAC ID: 3870527641 Enrollment ID: I20050921000461 |
| Provider Name | Ayman Jamal |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1083600845 PECOS PAC ID: 9436114915 Enrollment ID: I20050927000129 |
| Provider Name | Barbara L Garcia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184618530 PECOS PAC ID: 6507891546 Enrollment ID: I20050928001273 |
| Provider Name | Shani S Saks |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1023001682 PECOS PAC ID: 5698790541 Enrollment ID: I20051010000644 |
| Provider Name | Poya Hedayati |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063523587 PECOS PAC ID: 4789601238 Enrollment ID: I20051025000294 |
| Provider Name | Peter W Mitchell |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1881686749 PECOS PAC ID: 8022094481 Enrollment ID: I20051103000952 |
| Provider Name | Timothy E Rider |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215998364 PECOS PAC ID: 4688693534 Enrollment ID: I20051121000380 |
| Provider Name | Ashesh H Sanghvi |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1336185685 PECOS PAC ID: 5193743102 Enrollment ID: I20051201000910 |
| Provider Name | Tanya B Evans |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528002441 PECOS PAC ID: 4385668078 Enrollment ID: I20060120000511 |
| Provider Name | Dustin C Waite |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1639119811 PECOS PAC ID: 2466467451 Enrollment ID: I20060213000343 |
| Provider Name | Matthew C Duke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992779250 PECOS PAC ID: 1557378288 Enrollment ID: I20060321000287 |
| Provider Name | Lance Richard Winter |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1386693976 PECOS PAC ID: 9133154651 Enrollment ID: I20060728000260 |
| Provider Name | Angela M Sturdivant |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689622086 PECOS PAC ID: 1355231788 Enrollment ID: I20060809000452 |
| Provider Name | Travis Campbell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1740375757 PECOS PAC ID: 8527066844 Enrollment ID: I20061121000551 |
| Provider Name | Kevin M Murphy |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881777613 PECOS PAC ID: 8325049299 Enrollment ID: I20070118000575 |
| Provider Name | Linda Greer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346297991 PECOS PAC ID: 3577665744 Enrollment ID: I20070220000141 |
| Provider Name | Aye Thandar Win |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1245251941 PECOS PAC ID: 3173596772 Enrollment ID: I20070306000517 |
| Provider Name | Robert M Evans |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881651362 PECOS PAC ID: 2466341623 Enrollment ID: I20070418000137 |
| Provider Name | Jaime R Cole |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1922196708 PECOS PAC ID: 0042316994 Enrollment ID: I20070509000502 |
| Provider Name | Vafa Ghaemmaghami |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1659352144 PECOS PAC ID: 7416970504 Enrollment ID: I20070626000827 |
| Provider Name | Tod M Sugihara |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962615856 PECOS PAC ID: 4284725268 Enrollment ID: I20070806000205 |
| Provider Name | Neal a Klein |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1639111743 PECOS PAC ID: 4880508704 Enrollment ID: I20070910000556 |
| Provider Name | Eric a Castaneda |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619936002 PECOS PAC ID: 1557455292 Enrollment ID: I20070925000686 |
| Provider Name | Stephanie Kneisley Pinchera |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1699962563 PECOS PAC ID: 8426144338 Enrollment ID: I20071023000309 |
| Provider Name | Corie S Kelly |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1598885170 PECOS PAC ID: 4587751953 Enrollment ID: I20071101000159 |
| Provider Name | Seth D Oesch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427030188 PECOS PAC ID: 1759471865 Enrollment ID: I20071213000129 |
| Provider Name | Imtiaz Ahmed |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881776821 PECOS PAC ID: 0143249607 Enrollment ID: I20080611000691 |
| Provider Name | Lillian M Berry |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619947850 PECOS PAC ID: 5597837864 Enrollment ID: I20080701000404 |
| Provider Name | Allison M Peckumn |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1023230778 PECOS PAC ID: 0244306231 Enrollment ID: I20080827000175 |
| Provider Name | Daniel T Fang |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1033170634 PECOS PAC ID: 5092873927 Enrollment ID: I20081022000334 |
| Provider Name | Mark S Bessette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265426407 PECOS PAC ID: 0446356992 Enrollment ID: I20090316000038 |
| Provider Name | Emile Manansala |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1568427219 PECOS PAC ID: 4284782582 Enrollment ID: I20090424000161 |
| Provider Name | Edward G Ghattas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164412466 PECOS PAC ID: 9436209798 Enrollment ID: I20090608000144 |
| Provider Name | Robert L Bierman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124023205 PECOS PAC ID: 0840341558 Enrollment ID: I20090619000114 |
| Provider Name | Robert M Shull |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1205047297 PECOS PAC ID: 8628120250 Enrollment ID: I20090713000590 |
| Provider Name | William Michael Jaffe |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1083648158 PECOS PAC ID: 6204883721 Enrollment ID: I20090812000473 |
| Provider Name | Nelson H Lim |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1366463168 PECOS PAC ID: 4385688233 Enrollment ID: I20090817000649 |
| Provider Name | Adam J Schwartz |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1104030006 PECOS PAC ID: 4789784398 Enrollment ID: I20090818000143 |
| Provider Name | Rahool S Karnik |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1932183563 PECOS PAC ID: 3274568928 Enrollment ID: I20090824000480 |
| Provider Name | Colette a Toronto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669474243 PECOS PAC ID: 4183776032 Enrollment ID: I20090825000213 |
| Provider Name | Tiffany a Nunnelley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386805034 PECOS PAC ID: 0345395471 Enrollment ID: I20090826000081 |
| Provider Name | Lorraine M Homes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255375481 PECOS PAC ID: 3476699885 Enrollment ID: I20091014000799 |
| Provider Name | Jose Ivan a Rago |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477714137 PECOS PAC ID: 0244379774 Enrollment ID: I20091123000418 |
| Provider Name | Jennifer L Willis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275731424 PECOS PAC ID: 5193864221 Enrollment ID: I20091203000393 |
| Provider Name | Jody a Eckhardt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871650564 PECOS PAC ID: 7012919723 Enrollment ID: I20091215000035 |
| Provider Name | Ian M Frankfort |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295790293 PECOS PAC ID: 5294712527 Enrollment ID: I20100205000136 |
| Provider Name | Kristin V Franco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932399870 PECOS PAC ID: 9537295035 Enrollment ID: I20100408000279 |
| Provider Name | George Paik |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1740266550 PECOS PAC ID: 8729102082 Enrollment ID: I20100824000729 |
| Provider Name | Amon T Ferry |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1669639613 PECOS PAC ID: 5395899389 Enrollment ID: I20100830001043 |
| Provider Name | Dan C Phan |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1689899601 PECOS PAC ID: 7214053792 Enrollment ID: I20100922000744 |
| Provider Name | Arcot S Premkumar |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1265496665 PECOS PAC ID: 7618972985 Enrollment ID: I20101124000195 |
| Provider Name | Perry a Brazel |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1023327251 PECOS PAC ID: 2264620798 Enrollment ID: I20101227000685 |
| Provider Name | Ashish Gupta |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1982782470 PECOS PAC ID: 7416041991 Enrollment ID: I20110105000049 |
| Provider Name | Maressa M Alejandro-reyes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750328969 PECOS PAC ID: 6002881935 Enrollment ID: I20110112000619 |
| Provider Name | Katerina S Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376837989 PECOS PAC ID: 4688844871 Enrollment ID: I20110825000472 |
| Provider Name | Sasi K Ghanta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114219789 PECOS PAC ID: 7416128061 Enrollment ID: I20110913000004 |
| Provider Name | Amy Soloman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1982723508 PECOS PAC ID: 1153429337 Enrollment ID: I20110915000190 |
| Provider Name | Shruti Badhwar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497918502 PECOS PAC ID: 0244406593 Enrollment ID: I20120109000238 |
| Provider Name | Danielle C Sturm |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1164709788 PECOS PAC ID: 6608034947 Enrollment ID: I20120216000289 |
| Provider Name | Neeta a Patil |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871800581 PECOS PAC ID: 8729262894 Enrollment ID: I20120803000748 |
| Provider Name | Christina M Khoury |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1609086081 PECOS PAC ID: 7719157411 Enrollment ID: I20120820001119 |
| Provider Name | Mittun C Patel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033366463 PECOS PAC ID: 8628225620 Enrollment ID: I20120827000611 |
| Provider Name | Basel Channis |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1982834594 PECOS PAC ID: 0345490736 Enrollment ID: I20121019000513 |
| Provider Name | Kristen a Jensen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770834798 PECOS PAC ID: 2062664857 Enrollment ID: I20121129000559 |
| Provider Name | Crystal Dawn Allison |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1023352580 PECOS PAC ID: 9537312749 Enrollment ID: I20130118000227 |
| Provider Name | Michelle M Mix |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1831385533 PECOS PAC ID: 9335215722 Enrollment ID: I20130417000684 |
| Provider Name | Gerrit Miller |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1750623401 PECOS PAC ID: 4587800396 Enrollment ID: I20130424000486 |
| Provider Name | Emun Abdu |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1811199912 PECOS PAC ID: 4385815166 Enrollment ID: I20130425000227 |
| Provider Name | Amy Jo Purvis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467708156 PECOS PAC ID: 5496992281 Enrollment ID: I20130515000434 |
| Provider Name | Alaina a Vacco |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1538400692 PECOS PAC ID: 7315185014 Enrollment ID: I20130606000837 |
| Provider Name | Oday Al Rabadi |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1972779643 PECOS PAC ID: 8325288277 Enrollment ID: I20130717000511 |
| Provider Name | Renee M Gazda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558591644 PECOS PAC ID: 9335382167 Enrollment ID: I20130827000530 |
| Provider Name | Kristen J Keller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619319753 PECOS PAC ID: 3274776471 Enrollment ID: I20130906000320 |
| Provider Name | Timothy M Bert |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1346465010 PECOS PAC ID: 4385888791 Enrollment ID: I20130924000745 |
| Provider Name | Dinraj B Hegde |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184612178 PECOS PAC ID: 0941240964 Enrollment ID: I20131022002343 |
| Provider Name | Sharon S Sadeghinia |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1770608275 PECOS PAC ID: 7113974916 Enrollment ID: I20131216001480 |
| Provider Name | Ethan E Meyer |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932532322 PECOS PAC ID: 2264669399 Enrollment ID: I20131218000365 |
| Provider Name | Margaret C Hunt |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770910820 PECOS PAC ID: 0547497364 Enrollment ID: I20131223001594 |
| Provider Name | Jignesh Patel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023136322 PECOS PAC ID: 8325198781 Enrollment ID: I20140225002080 |
| Provider Name | Adam Micheal Sproat |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1376772152 PECOS PAC ID: 8022233261 Enrollment ID: I20140702001553 |
| Provider Name | Michael J Sumko |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1992937189 PECOS PAC ID: 6507098845 Enrollment ID: I20140804002160 |
| Provider Name | Jacob T Woods |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235424680 PECOS PAC ID: 1052538352 Enrollment ID: I20140811001112 |
| Provider Name | Kristen L Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407279748 PECOS PAC ID: 4880812346 Enrollment ID: I20140825001138 |
| Provider Name | Eric Tomas Ovalle |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003211889 PECOS PAC ID: 9436473444 Enrollment ID: I20150122002086 |
| Provider Name | Samyuktha Sreenivasan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548526171 PECOS PAC ID: 4284947730 Enrollment ID: I20150713003183 |
| Provider Name | Donny Small |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1619352796 PECOS PAC ID: 0143537548 Enrollment ID: I20150917001308 |
| Provider Name | Amanda Christie Rapp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104192525 PECOS PAC ID: 2163739137 Enrollment ID: I20150923003182 |
| Provider Name | Helena In't Veld |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982071429 PECOS PAC ID: 8426366063 Enrollment ID: I20151001001710 |
| Provider Name | Karthik Raghavan |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164699906 PECOS PAC ID: 9739204371 Enrollment ID: I20151005001865 |
| Provider Name | Jenny Ho |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427315506 PECOS PAC ID: 8022327121 Enrollment ID: I20151012000590 |
| Provider Name | Gregory M Kohler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912383522 PECOS PAC ID: 2668772468 Enrollment ID: I20151203003278 |
| Provider Name | Saifuldeen a Al Qaisi |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1053673723 PECOS PAC ID: 0042516684 Enrollment ID: I20160308002812 |
| Provider Name | Timothy J Meier |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1720015118 PECOS PAC ID: 3971516014 Enrollment ID: I20160317000032 |
| Provider Name | Lara Shleef |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1013330992 PECOS PAC ID: 3870890197 Enrollment ID: I20160330002595 |
| Provider Name | Camilla Rae Jensen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1245584085 PECOS PAC ID: 1658525001 Enrollment ID: I20160606000229 |
| Provider Name | Basil Al Khatib |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1083977599 PECOS PAC ID: 3476845082 Enrollment ID: I20160629003119 |
| Provider Name | Tushar Gohel |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1568699304 PECOS PAC ID: 7911163571 Enrollment ID: I20160630000517 |
| Provider Name | Tracy L Von Aspen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447605639 PECOS PAC ID: 0547553000 Enrollment ID: I20160721002188 |
| Provider Name | Gina Marie Mathew |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1366731358 PECOS PAC ID: 5698085660 Enrollment ID: I20160812001431 |
| Provider Name | Rachel E Fairman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1659746493 PECOS PAC ID: 6002101912 Enrollment ID: I20160816003032 |
| Provider Name | Archana Nagarajan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881906733 PECOS PAC ID: 0749415818 Enrollment ID: I20160907002194 |
| Provider Name | Mohammad Monjurul Alam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356574016 PECOS PAC ID: 1355592304 Enrollment ID: I20160928001100 |
| Provider Name | Vinay Kapadia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598212003 PECOS PAC ID: 0143509554 Enrollment ID: I20161107002498 |
| Provider Name | Nathaniel Spencer Harriman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1053862300 PECOS PAC ID: 8527347186 Enrollment ID: I20161122002279 |
| Provider Name | Ryan a Pinnell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1174818173 PECOS PAC ID: 4082994363 Enrollment ID: I20161201002087 |
| Provider Name | Julie L Hildebrand |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1497811251 PECOS PAC ID: 2769514173 Enrollment ID: I20170320001301 |
| Provider Name | Megan Bermudez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104377506 PECOS PAC ID: 5395020648 Enrollment ID: I20170329000023 |
| Provider Name | Melinda Newman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457743569 PECOS PAC ID: 6305166422 Enrollment ID: I20170718001732 |
| Provider Name | Carly Anne Ernst |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891112900 PECOS PAC ID: 5294030474 Enrollment ID: I20170725001581 |
| Provider Name | Maria Viadimir Gibson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649388596 PECOS PAC ID: 2860428489 Enrollment ID: I20170807003307 |
| Provider Name | Heatherann a Bal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518379031 PECOS PAC ID: 1254621659 Enrollment ID: I20170815000635 |
| Provider Name | David E Virgil |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598175747 PECOS PAC ID: 8820360449 Enrollment ID: I20170816004229 |
| Provider Name | Melissa S Molyneux |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053722686 PECOS PAC ID: 7012281637 Enrollment ID: I20170920003880 |
| Provider Name | Nickalaus L Gramze |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1487972964 PECOS PAC ID: 0749459410 Enrollment ID: I20170927004188 |
| Provider Name | Dawn Michelle Maxwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487163218 PECOS PAC ID: 0143114462 Enrollment ID: I20171023002529 |
| Provider Name | Matthew Shannon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1851800049 PECOS PAC ID: 2769748094 Enrollment ID: I20171102001010 |
| Provider Name | Marium Muzaffar |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1306191242 PECOS PAC ID: 4385947902 Enrollment ID: I20171128003220 |
| Provider Name | Jasson Castano |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619480977 PECOS PAC ID: 6507126745 Enrollment ID: I20180207001445 |
| Provider Name | Maja Teoharevic |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1467970640 PECOS PAC ID: 1456612688 Enrollment ID: I20180302000643 |
| Provider Name | Jenna L Gonzales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275048357 PECOS PAC ID: 4385906007 Enrollment ID: I20180316001383 |
| Provider Name | Amber R Senator |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558863597 PECOS PAC ID: 2567724883 Enrollment ID: I20180327001568 |
| Provider Name | Leslee Hamadeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144728130 PECOS PAC ID: 3678835782 Enrollment ID: I20180328003071 |
| Provider Name | Roberto Calderon |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1568649812 PECOS PAC ID: 7911030267 Enrollment ID: I20180412002000 |
| Provider Name | Merima Bucaj |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417245267 PECOS PAC ID: 4385896000 Enrollment ID: I20180417000728 |
| Provider Name | Aaron P Shaw |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1851759724 PECOS PAC ID: 2062719420 Enrollment ID: I20180507002193 |
| Provider Name | Angela Marie Calderon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1114230513 PECOS PAC ID: 3173829280 Enrollment ID: I20180508000228 |
| Provider Name | Jai S Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407892268 PECOS PAC ID: 2163495953 Enrollment ID: I20180515001767 |
| Provider Name | Drew K Lambourne |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184930786 PECOS PAC ID: 5294927000 Enrollment ID: I20180517001990 |
| Provider Name | Leonid Vydro |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1902148380 PECOS PAC ID: 7911299987 Enrollment ID: I20180521003232 |
| Provider Name | Cristina Pecci |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1588041057 PECOS PAC ID: 2264797836 Enrollment ID: I20180531002401 |
| Provider Name | Joshua Scott Silver |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1790044204 PECOS PAC ID: 3476809336 Enrollment ID: I20180706001411 |
| Provider Name | Ammar M Alobaidy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1437592102 PECOS PAC ID: 1658629597 Enrollment ID: I20180808003204 |
| Provider Name | Craig M Tambatamba |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1639667405 PECOS PAC ID: 3274882212 Enrollment ID: I20180823002436 |
| Provider Name | Savio C Reddymasu |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1598981979 PECOS PAC ID: 4183724248 Enrollment ID: I20181002000099 |
| Provider Name | Nichole Marie Krueger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811483415 PECOS PAC ID: 0345592994 Enrollment ID: I20181009001387 |
| Provider Name | Anne Elizabeth Puggini |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548749690 PECOS PAC ID: 5496008765 Enrollment ID: I20181102001777 |
| Provider Name | Lesley K Howard |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1255812491 PECOS PAC ID: 8123363967 Enrollment ID: I20181221002287 |
| Provider Name | Ethan Everlith |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003391434 PECOS PAC ID: 1557607082 Enrollment ID: I20190103003273 |
| Provider Name | Rishi Kirit Patel |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1972794659 PECOS PAC ID: 8729148358 Enrollment ID: I20190104001864 |
| Provider Name | Jamie Lee Anderson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1154896058 PECOS PAC ID: 9931445152 Enrollment ID: I20190109001515 |
| Provider Name | Brooke E Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194293043 PECOS PAC ID: 9830437458 Enrollment ID: I20190206001870 |
| Provider Name | Melissa Sue Strang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750850830 PECOS PAC ID: 1850630823 Enrollment ID: I20190308002217 |
| Provider Name | Jacob Tuttle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023370053 PECOS PAC ID: 1759529704 Enrollment ID: I20190327001275 |
| Provider Name | Maria Norivic Laraya Soriano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134602923 PECOS PAC ID: 7416298203 Enrollment ID: I20190403003246 |
| Provider Name | Sushant Punjaram Kale |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780809798 PECOS PAC ID: 1456490077 Enrollment ID: I20190521001296 |
| Provider Name | Lige Kaplan |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1780894949 PECOS PAC ID: 5294809802 Enrollment ID: I20190529001282 |
| Provider Name | Angela Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689130007 PECOS PAC ID: 3678806916 Enrollment ID: I20190531000973 |
| Provider Name | Alexander Lewis Coon |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1720124084 PECOS PAC ID: 0244361251 Enrollment ID: I20190612003240 |
| Provider Name | Olivia Marie Marshall |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1639522766 PECOS PAC ID: 8729340906 Enrollment ID: I20190710001846 |
| Provider Name | Tina Marie Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700341831 PECOS PAC ID: 9830426618 Enrollment ID: I20190816001854 |
| Provider Name | Matthew a Wade |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1699169003 PECOS PAC ID: 6204139017 Enrollment ID: I20190822002177 |
| Provider Name | Tim Michael Ratliff |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1306227780 PECOS PAC ID: 4486966017 Enrollment ID: I20191001002876 |
| Provider Name | Alec Pramhus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225481740 PECOS PAC ID: 1557656204 Enrollment ID: I20191001003263 |
| Provider Name | Diana Thayer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063975076 PECOS PAC ID: 5092045294 Enrollment ID: I20191002001028 |
| Provider Name | Santiago a Chavez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1295811677 PECOS PAC ID: 7911009584 Enrollment ID: I20191003003601 |
| Provider Name | Mollanda Laura Mazzo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801440904 PECOS PAC ID: 1052642840 Enrollment ID: I20191009000742 |
| Provider Name | Lindsay Calderon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184026031 PECOS PAC ID: 0547550469 Enrollment ID: I20191022003955 |
| Provider Name | Jayme L Hawthorne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619489911 PECOS PAC ID: 5294168951 Enrollment ID: I20191210003290 |
| Provider Name | Hannah Elizabeth Johnston |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1306497896 PECOS PAC ID: 2860825536 Enrollment ID: I20191211000530 |
| Provider Name | Ruby L Russell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619496999 PECOS PAC ID: 3779844238 Enrollment ID: I20191212000443 |
| Provider Name | Stephanie Sheree Meyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790334233 PECOS PAC ID: 3072940899 Enrollment ID: I20200217001484 |
| Provider Name | Ryan Hill-falkenthal |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1437780665 PECOS PAC ID: 3870922859 Enrollment ID: I20200327000263 |
| Provider Name | Carl B Bryce |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619315074 PECOS PAC ID: 4183867633 Enrollment ID: I20200408000345 |
| Provider Name | Megan Wienecke |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1720591241 PECOS PAC ID: 7113273905 Enrollment ID: I20200428001767 |
| Provider Name | Mimi Van |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1801298294 PECOS PAC ID: 0244528024 Enrollment ID: I20200513001155 |
| Provider Name | Shelly Bansal |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1174793111 PECOS PAC ID: 4688801806 Enrollment ID: I20200526001717 |
| Provider Name | Samuel C Kim |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1215917091 PECOS PAC ID: 1759317720 Enrollment ID: I20200602002929 |
| Provider Name | Benjamin Albert |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1235494741 PECOS PAC ID: 9830415512 Enrollment ID: I20200804002065 |
| Provider Name | Brent Rich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982614319 PECOS PAC ID: 7911991450 Enrollment ID: I20200804002115 |
| Provider Name | Karina Mendez Colon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1023653573 PECOS PAC ID: 9739507112 Enrollment ID: I20200824000408 |
| Provider Name | Theron Liddell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528515939 PECOS PAC ID: 2668744673 Enrollment ID: I20200921001545 |
| Provider Name | Allyson Mclean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679964662 PECOS PAC ID: 5092032656 Enrollment ID: I20201013000362 |
| Provider Name | Scott Barry |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1710947874 PECOS PAC ID: 5294991964 Enrollment ID: I20201020001444 |
| Provider Name | Lakshmi Kocherlakota |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386171320 PECOS PAC ID: 2062752165 Enrollment ID: I20201026000825 |
| Provider Name | Deanna Fussy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972100097 PECOS PAC ID: 7618387820 Enrollment ID: I20201029000345 |
| Provider Name | Tyler Joseph Burg |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1144749250 PECOS PAC ID: 2860759727 Enrollment ID: I20210108001080 |
| Provider Name | Desiree Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326678319 PECOS PAC ID: 0446663181 Enrollment ID: I20210119001806 |
| Provider Name | Suzzan Michelle Tarno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376571778 PECOS PAC ID: 3476582123 Enrollment ID: I20210119002794 |
| Provider Name | Gregory Robert Billings |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1598340044 PECOS PAC ID: 9133536386 Enrollment ID: I20210406000581 |
| Provider Name | Patricia Bonasera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790378230 PECOS PAC ID: 1951719160 Enrollment ID: I20210427002459 |
| Provider Name | Dushyant Mann |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477932432 PECOS PAC ID: 2860786969 Enrollment ID: I20210621000676 |
| Provider Name | Dinesh K Sundarakumar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417235714 PECOS PAC ID: 5193024412 Enrollment ID: I20210625002455 |
| Provider Name | Demetrios K. Mavroidis |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1184602914 PECOS PAC ID: 5092740548 Enrollment ID: I20210701001817 |
| Provider Name | Ish Singla |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1215111422 PECOS PAC ID: 1254572134 Enrollment ID: I20210707003586 |
| Provider Name | Ugonna Ezeh |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1629423223 PECOS PAC ID: 3476957226 Enrollment ID: I20210802002077 |
| Provider Name | Talon Perry Jumper |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1609442227 PECOS PAC ID: 8628472149 Enrollment ID: I20210805002285 |
| Provider Name | Richard Dung Pham |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1124439377 PECOS PAC ID: 7719381987 Enrollment ID: I20210810002458 |
| Provider Name | Jaharris Ahmed Collier |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1679928436 PECOS PAC ID: 6800180589 Enrollment ID: I20210825002796 |
| Provider Name | Shashank Jain |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1588824007 PECOS PAC ID: 2264604685 Enrollment ID: I20210826002528 |
| Provider Name | Subhash Chandra |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1174817720 PECOS PAC ID: 4183874894 Enrollment ID: I20210831002187 |
| Provider Name | Rico Andrew Segun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760055099 PECOS PAC ID: 8628474186 Enrollment ID: I20210908002484 |
| Provider Name | Neil Vyas |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1447678917 PECOS PAC ID: 1951709799 Enrollment ID: I20211008002559 |
| Provider Name | Justin Fuller |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1962176917 PECOS PAC ID: 4880082619 Enrollment ID: I20211028001039 |
| Provider Name | Sherry Caforio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609363159 PECOS PAC ID: 1557759925 Enrollment ID: I20211104001100 |
| Provider Name | Jennifer Marie Vargas |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578139226 PECOS PAC ID: 8820487028 Enrollment ID: I20211109002380 |
| Provider Name | Taylor a English |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1053083279 PECOS PAC ID: 4789073420 Enrollment ID: I20211117003190 |
| Provider Name | Jacob Pfetsch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639756356 PECOS PAC ID: 1850782095 Enrollment ID: I20211227000520 |
| Provider Name | Stacey Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831637529 PECOS PAC ID: 2163706565 Enrollment ID: I20220304001952 |
| Provider Name | Brooke Elizabeth Hite |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992384754 PECOS PAC ID: 8123413978 Enrollment ID: I20220315001175 |
| Provider Name | Steven Mitchell Bernstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164453585 PECOS PAC ID: 3577456540 Enrollment ID: I20220423000080 |
| Provider Name | Roshan Kottoor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1598243701 PECOS PAC ID: 7315280658 Enrollment ID: I20220509000268 |
| Provider Name | Curtis Simmons |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700248820 PECOS PAC ID: 2163718446 Enrollment ID: I20220613002104 |
| Provider Name | Loui Rejjal |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1073931846 PECOS PAC ID: 7214156546 Enrollment ID: I20220728000546 |
| Provider Name | Cameron Teutschel Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619427523 PECOS PAC ID: 5698024115 Enrollment ID: I20220805002836 |
| Provider Name | Shannon M Jennings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396493789 PECOS PAC ID: 1254714629 Enrollment ID: I20220817002420 |
| Provider Name | Akram Ibrahim |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1508029802 PECOS PAC ID: 7214229152 Enrollment ID: I20220817002449 |
| Provider Name | Kelly Nathan Shortridge |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1558728196 PECOS PAC ID: 6800291196 Enrollment ID: I20220830002113 |
| Provider Name | Jordan Lee Liles |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1952764219 PECOS PAC ID: 1456736289 Enrollment ID: I20220915000923 |
| Provider Name | Alexandra Farmer |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1689313868 PECOS PAC ID: 2961878053 Enrollment ID: I20221013003744 |
| Provider Name | Kaitlin M Hart |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1205562394 PECOS PAC ID: 7719354919 Enrollment ID: I20221101000544 |
| Provider Name | Jaimie R Aguirre |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1891415253 PECOS PAC ID: 6305213968 Enrollment ID: I20221110001975 |
| Provider Name | Carmela Marfori Fernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013633643 PECOS PAC ID: 2961870613 Enrollment ID: I20221130001666 |
| Provider Name | Katherine Theresa Ruddy |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1669180055 PECOS PAC ID: 3476924366 Enrollment ID: I20230201002230 |
| Provider Name | Erika Rachael Steele |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1427338995 PECOS PAC ID: 9032381512 Enrollment ID: I20230314002200 |
| Provider Name | Maricel Olan-cabrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659617850 PECOS PAC ID: 2163653007 Enrollment ID: I20230316001701 |
| Provider Name | Julia Lauren Diab |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1609582386 PECOS PAC ID: 9830564657 Enrollment ID: I20230410001797 |
| Provider Name | Shannon Kleinschmidt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164123725 PECOS PAC ID: 1355706565 Enrollment ID: I20230421002214 |
| Provider Name | Abeer a Mousa |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225693310 PECOS PAC ID: 0941623052 Enrollment ID: I20230428001189 |
| Provider Name | Benjamin Weigman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881222115 PECOS PAC ID: 6002234853 Enrollment ID: I20230516002850 |
| Provider Name | Sami Rafael Kaldawi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598260457 PECOS PAC ID: 9931566387 Enrollment ID: I20230531001116 |
| Provider Name | Fahad Laghari |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1750810404 PECOS PAC ID: 0648549006 Enrollment ID: I20230607001609 |
| Provider Name | Hao Pan |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1184986838 PECOS PAC ID: 0648524207 Enrollment ID: I20230621001259 |
| Provider Name | Mario Lant |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1811651193 PECOS PAC ID: 4082072947 Enrollment ID: I20230626000104 |
| Provider Name | Thomas Frank |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1477908994 PECOS PAC ID: 6103105358 Enrollment ID: I20230626002373 |
| Provider Name | Logan Henry |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1609545177 PECOS PAC ID: 4587053301 Enrollment ID: I20230630002894 |
| Provider Name | Brendan Koistinen |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1457812422 PECOS PAC ID: 4789913070 Enrollment ID: I20230718004299 |
| Provider Name | Kimberlee Van Orden |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447742127 PECOS PAC ID: 1658622360 Enrollment ID: I20230724003179 |
| Provider Name | Tiffany Millett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457820334 PECOS PAC ID: 9335486455 Enrollment ID: I20230728000415 |
| Provider Name | Eduardo Salazar |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1689105546 PECOS PAC ID: 9638531296 Enrollment ID: I20230814001717 |
| Provider Name | David M Prutzman |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1477993152 PECOS PAC ID: 6406139716 Enrollment ID: I20230829004440 |
| Provider Name | Daphne Schnase-steier |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1699883967 PECOS PAC ID: 4880796812 Enrollment ID: I20230831002990 |
| Provider Name | Susan Lynn Stefanski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720511645 PECOS PAC ID: 5698043669 Enrollment ID: I20230919001840 |
| Provider Name | Omar Kaddurah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144715186 PECOS PAC ID: 6901152503 Enrollment ID: I20230922000005 |
| Provider Name | Hector Rafael Vazquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366122525 PECOS PAC ID: 0042666455 Enrollment ID: I20231020002241 |
| Provider Name | Aleksandar Blascak |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1992439178 PECOS PAC ID: 7618324419 Enrollment ID: I20231116001245 |
| Provider Name | Jennifer Huynhfantroy Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952922395 PECOS PAC ID: 8527484153 Enrollment ID: I20240116004173 |
| Provider Name | Abhinav Patel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013447820 PECOS PAC ID: 0244581072 Enrollment ID: I20240216003994 |
| Provider Name | Akash M Doshi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790245520 PECOS PAC ID: 0143643163 Enrollment ID: I20240404000681 |
| Provider Name | Bryan P Hunter |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1740343383 PECOS PAC ID: 2860385077 Enrollment ID: I20240419001681 |
| Provider Name | Lindsay Grissett Curran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336909886 PECOS PAC ID: 4789025834 Enrollment ID: I20240507004297 |
| Provider Name | Matthew Cale Britton |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629456769 PECOS PAC ID: 2365747284 Enrollment ID: I20240523001952 |
| Provider Name | Jason Lee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417410804 PECOS PAC ID: 3971830092 Enrollment ID: I20240607003524 |
| Provider Name | Natasha Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023537263 PECOS PAC ID: 6002173291 Enrollment ID: I20240705002529 |
| Provider Name | Kristina Skinner |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1790191039 PECOS PAC ID: 8224353313 Enrollment ID: I20240719002639 |
| Provider Name | Nicholas Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780431007 PECOS PAC ID: 6002352184 Enrollment ID: I20240725000372 |
| Provider Name | David G Norton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891274841 PECOS PAC ID: 4981933389 Enrollment ID: I20240802002938 |
| Provider Name | Hisham a Kaddurah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376004325 PECOS PAC ID: 9335573864 Enrollment ID: I20240808003051 |
| Provider Name | Tanner Thomas Mcclure |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1821599036 PECOS PAC ID: 2961750500 Enrollment ID: I20240814004549 |
| Provider Name | Madeline Maura Lyons |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1912401654 PECOS PAC ID: 8628325412 Enrollment ID: I20240822004449 |
| Provider Name | Lloyd M. Kershen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285877233 PECOS PAC ID: 1052569282 Enrollment ID: I20240910000851 |
| Provider Name | Maedeh Khayyat Kholghi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1376049528 PECOS PAC ID: 5799036083 Enrollment ID: I20240920002283 |
| Provider Name | James Y Kim |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1730262882 PECOS PAC ID: 1254417785 Enrollment ID: I20241018002897 |
| Provider Name | Julia Anne Kemper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508686726 PECOS PAC ID: 6002340486 Enrollment ID: I20241107001495 |
| Provider Name | Andrew Nguyen Ho |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1801580220 PECOS PAC ID: 3779010541 Enrollment ID: I20241218003203 |
| Provider Name | Amy Kathryn Wifler |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1417770264 PECOS PAC ID: 9931636560 Enrollment ID: I20241220001923 |
| Provider Name | Geoffrey Phillip Colby |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1144373739 PECOS PAC ID: 9537310933 Enrollment ID: I20241230002301 |
| Provider Name | Alejandra Navarro Castaneda |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1487219002 PECOS PAC ID: 2264960020 Enrollment ID: I20250108001725 |
| Provider Name | Elizabeth Amy Steffens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952123077 PECOS PAC ID: 6507388766 Enrollment ID: I20250317002877 |
| Provider Name | Taylor Elizabeth Lawson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184434870 PECOS PAC ID: 8325562705 Enrollment ID: I20250407002905 |
| Provider Name | Brittany Leigh Garnett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992577530 PECOS PAC ID: 3870028269 Enrollment ID: I20250423001094 |
| Provider Name | Meghan Rettler |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1275336141 PECOS PAC ID: 0042737355 Enrollment ID: I20250509001943 |
| Provider Name | Richard Joseph Wruble |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164059531 PECOS PAC ID: 5294253613 Enrollment ID: I20250519002707 |
| Provider Name | Gabriel Stephen Ruiz |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1649833732 PECOS PAC ID: 1456686047 Enrollment ID: I20250523002599 |
| Provider Name | Caleb Boehler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508495367 PECOS PAC ID: 7911321450 Enrollment ID: I20250527003032 |
| Provider Name | Khalid Eteer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699396549 PECOS PAC ID: 0244740686 Enrollment ID: I20250605003541 |
| Provider Name | Naomi Kis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033746417 PECOS PAC ID: 0840618468 Enrollment ID: I20250630002561 |
| Provider Name | Jordan Parish Conroy |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1568099802 PECOS PAC ID: 6709200959 Enrollment ID: I20250806003952 |
| Provider Name | Geoffrey I Boyer |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1225667033 PECOS PAC ID: 9234555814 Enrollment ID: I20250813004285 |
| Provider Name | Michelle Melody Son |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1518520444 PECOS PAC ID: 9739414210 Enrollment ID: I20250819004531 |
| Provider Name | Andrew Emil Makar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326781865 PECOS PAC ID: 3476934852 Enrollment ID: I20250820000995 |
| Provider Name | Melinda Christine Arthur |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801474648 PECOS PAC ID: 4789185042 Enrollment ID: I20250828002629 |
| Provider Name | David Jacob Tramutolo |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1912535782 PECOS PAC ID: 1658773197 Enrollment ID: I20250829003831 |
| Provider Name | Ali Raza Ghani |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1013392018 PECOS PAC ID: 8628382546 Enrollment ID: I20250908003387 |
| Provider Name | Mary In-ping Huang Cobb |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1730492836 PECOS PAC ID: 8224399159 Enrollment ID: I20250915001964 |
| Provider Name | Emmanuel Cruz Gorospe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225160427 PECOS PAC ID: 2769515758 Enrollment ID: I20251107003167 |
| Provider Name | Pamela Valka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174521207 PECOS PAC ID: 5698872216 Enrollment ID: I20251122001204 |
| Provider Name | Hadiatou Barry |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1225565880 PECOS PAC ID: 5698045540 Enrollment ID: I20260121002754 |
| Provider Name | James S Mackenzie |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1164876413 PECOS PAC ID: 1850678244 Enrollment ID: I20260204001301 |
| Provider Name | Karina Teresa Escobedo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457219552 PECOS PAC ID: 9638644024 Enrollment ID: I20260414000975 |
| Provider Name | Lander Cabrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588281547 PECOS PAC ID: 1456827708 Enrollment ID: I20260415002150 |
| Provider Name | Erich Mussak |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639343148 PECOS PAC ID: 2264698471 Enrollment ID: I20260429003988 |
| Provider Name | Alexander Abdullayev |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1538693015 PECOS PAC ID: 8426335134 Enrollment ID: I20260513003208 |
| Provider Name | Salil Kalarn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1942876149 PECOS PAC ID: 3375944374 Enrollment ID: I20260518001330 |
| Provider Name | Austin Pickrell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205419363 PECOS PAC ID: 0749661015 Enrollment ID: I20260603001499 |
Wildflower Therapy Services LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17926 W Hammond St, Goodyear, AZ 85338 Phone: 623-238-5075 |
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