| University Of Washington Medical Center | |
|
1959 Ne Pacific St Seattle WA 98195-0001 | |
| (206) 598-3300 | |
| (206) 598-0961 |
| Full Name | University Of Washington Medical Center |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 1959 Ne Pacific St, Seattle, Washington |
| Authorized Official Name and Position | Cynthia J. Hecker (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2066682774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| University Of Washington Medical Center Po Box 24366 Seattle WA 98124-0366 Ph: (206) 598-0502 | University Of Washington Medical Center 1959 Ne Pacific St Seattle WA 98195-0001 Ph: (206) 598-3300 |
| NPI Number | 1326002049 |
|---|---|
| Provider Enumeration Date | 04/12/2006 |
| Last Update Date | 05/20/2021 |
| Medicare PECOS PAC ID | 3274445150 |
|---|---|
| Medicare Enrollment ID | O20040105000544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326002049 | NPI | - | NPPES |
| 4923822 | Other | WA | NCPDP - UWMC - ROOSEVELT |
| 7089113 | Medicaid | WA | |
| 0170851 | Other | WA | L&I CRNA |
| 7082704 | Medicaid | WA | |
| 7117476 | Medicaid | WA | |
| 8940597 | Other | WA | L&I CRIME VICTIMS CRNA |
| 7091846 | Medicaid | WA | |
| 9616129 | Medicaid | WA | |
| 0025694 | Other | WA | L&I GENERAL |
| 9007352 | Medicaid | WA | |
| 4915849 | Other | WA | NCPDP-UWMC - PACIFIC |
| 4906888 | Other | WA | NCPDP - UWMC-HALL HEALTH |
| 7096043 | Medicaid | WA | |
| 8852642 | Other | WA | MEDICARE DENTAL |
| 9636606 | Medicaid | WA |
| Provider Name | Wayne Cecil Levy |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1679663538 PECOS PAC ID: 7719870427 Enrollment ID: I20040205001179 |
| Provider Name | Kori A Dewing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073681946 PECOS PAC ID: 8224021860 Enrollment ID: I20040407001376 |
| Provider Name | Mark W Stivers |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1316946437 PECOS PAC ID: 0244122281 Enrollment ID: I20040412000403 |
| Provider Name | Jonathan Halper |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114952082 PECOS PAC ID: 6507852357 Enrollment ID: I20040426000487 |
| Provider Name | Jaqueline G Raetz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881770535 PECOS PAC ID: 9537150164 Enrollment ID: I20040521000247 |
| Provider Name | Owen R Beirne |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1366531543 PECOS PAC ID: 5294637054 Enrollment ID: I20040616001122 |
| Provider Name | Richard W Tobin |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1700857547 PECOS PAC ID: 4981691193 Enrollment ID: I20040702000172 |
| Provider Name | Carol Anne Stimson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427076512 PECOS PAC ID: 1254303092 Enrollment ID: I20040811000759 |
| Provider Name | Matthew M Rice |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083656136 PECOS PAC ID: 6002717428 Enrollment ID: I20040928000940 |
| Provider Name | Larayne Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376592824 PECOS PAC ID: 1557321981 Enrollment ID: I20041012000133 |
| Provider Name | Susan Mantaring Treharne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245292622 PECOS PAC ID: 2961467196 Enrollment ID: I20041129000895 |
| Provider Name | Alexandra Moretti Morrison |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1760531867 PECOS PAC ID: 0749239176 Enrollment ID: I20050112000987 |
| Provider Name | Jeffrey J Sherman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316036593 PECOS PAC ID: 9931158748 Enrollment ID: I20050119000742 |
| Provider Name | Jeudiel Robert Puente |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1699737395 PECOS PAC ID: 9931159472 Enrollment ID: I20050124000255 |
| Provider Name | Patricia P Hardman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871511147 PECOS PAC ID: 8325095987 Enrollment ID: I20050405001375 |
| Provider Name | Ivan Rothman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932127115 PECOS PAC ID: 9638126154 Enrollment ID: I20050406000485 |
| Provider Name | Beatrice K Gandara |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1437248689 PECOS PAC ID: 7517906076 Enrollment ID: I20050426000211 |
| Provider Name | Mark T Drangsholt |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1033208384 PECOS PAC ID: 0244279719 Enrollment ID: I20050426000221 |
| Provider Name | Edmond L Truelove |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1932284940 PECOS PAC ID: 8325948300 Enrollment ID: I20050426000242 |
| Provider Name | Michael D Martin |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1407945660 PECOS PAC ID: 2062451453 Enrollment ID: I20050426000451 |
| Provider Name | Jeffrey E Rubenstein |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1164519492 PECOS PAC ID: 3375582760 Enrollment ID: I20050426000484 |
| Provider Name | Dolphine Oda |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1710077532 PECOS PAC ID: 8729027123 Enrollment ID: I20050426000510 |
| Provider Name | Michael John Grodesky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164440434 PECOS PAC ID: 1153360847 Enrollment ID: I20050502001186 |
| Provider Name | Pamela L Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548288665 PECOS PAC ID: 6608818612 Enrollment ID: I20050531000485 |
| Provider Name | Marie A Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659321511 PECOS PAC ID: 2668415985 Enrollment ID: I20050608000169 |
| Provider Name | Steven H Mitchell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760422604 PECOS PAC ID: 1355377839 Enrollment ID: I20050715000598 |
| Provider Name | Mary E Schlater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982622171 PECOS PAC ID: 8921038191 Enrollment ID: I20050817000412 |
| Provider Name | Medley O'keele Gatewood |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285719013 PECOS PAC ID: 6901838481 Enrollment ID: I20050906000572 |
| Provider Name | Stephanie M Cooper |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962468934 PECOS PAC ID: 9830114446 Enrollment ID: I20051012001241 |
| Provider Name | Phillip Keith Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093734618 PECOS PAC ID: 7416977087 Enrollment ID: I20051128000532 |
| Provider Name | Melanie S Lang |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1861486458 PECOS PAC ID: 5193743136 Enrollment ID: I20051207000422 |
| Provider Name | Susan L Williams-judge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427126390 PECOS PAC ID: 1153343330 Enrollment ID: I20060103000180 |
| Provider Name | Daniel Dean Langille |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1740242809 PECOS PAC ID: 9931115052 Enrollment ID: I20060228000067 |
| Provider Name | Kumhee A Ro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093740565 PECOS PAC ID: 8325055544 Enrollment ID: I20060314000160 |
| Provider Name | Brian Michael Buchanan |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1134181852 PECOS PAC ID: 6103833074 Enrollment ID: I20060317000190 |
| Provider Name | Julie L Carkin |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1083601579 PECOS PAC ID: 1456368273 Enrollment ID: I20060320000092 |
| Provider Name | Sunil K Ummat |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1982675567 PECOS PAC ID: 3274543244 Enrollment ID: I20060605000060 |
| Provider Name | Jamie Rae Shandro |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992742530 PECOS PAC ID: 8325057656 Enrollment ID: I20060616000238 |
| Provider Name | Amber Marlina Ross |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1366495921 PECOS PAC ID: 6103838719 Enrollment ID: I20060623000249 |
| Provider Name | Myla R Morales Tomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538196316 PECOS PAC ID: 2567467707 Enrollment ID: I20060922000122 |
| Provider Name | Arunachalam Einstein |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013943752 PECOS PAC ID: 3870518475 Enrollment ID: I20061102000598 |
| Provider Name | Nils W Naviaux |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821107178 PECOS PAC ID: 1951296524 Enrollment ID: I20061113000100 |
| Provider Name | John Charles Lusk |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932208592 PECOS PAC ID: 0547268286 Enrollment ID: I20061113000544 |
| Provider Name | Carlton E Heine |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1851328421 PECOS PAC ID: 6406854488 Enrollment ID: I20061130000061 |
| Provider Name | Eugene Yang |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1184654782 PECOS PAC ID: 8123006822 Enrollment ID: I20061212000552 |
| Provider Name | Stephanie H Richling |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104864875 PECOS PAC ID: 7719958404 Enrollment ID: I20070119000119 |
| Provider Name | Barbara Bjeletich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669465027 PECOS PAC ID: 9739130790 Enrollment ID: I20070215000746 |
| Provider Name | Regine Renee Aleta Zeigler |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1588750939 PECOS PAC ID: 6305940503 Enrollment ID: I20070328000240 |
| Provider Name | Patrick L Klimczyk |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1700923026 PECOS PAC ID: 9133224793 Enrollment ID: I20070410000692 |
| Provider Name | Laura Beth Byrne |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1306990932 PECOS PAC ID: 9335244730 Enrollment ID: I20070413000043 |
| Provider Name | Deanna M Martin |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1598819138 PECOS PAC ID: 1759486152 Enrollment ID: I20070413000083 |
| Provider Name | Linda Lou Marriott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427084458 PECOS PAC ID: 6901902352 Enrollment ID: I20070502000282 |
| Provider Name | Claudia A Finkelstein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245316090 PECOS PAC ID: 3274639455 Enrollment ID: I20070504000066 |
| Provider Name | Francisco A De La Fuente |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972710457 PECOS PAC ID: 5991897779 Enrollment ID: I20070824000200 |
| Provider Name | Darrell Alen Owens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366633810 PECOS PAC ID: 8527151356 Enrollment ID: I20070910000522 |
| Provider Name | Brandon Heath Backlund |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902902984 PECOS PAC ID: 5496728362 Enrollment ID: I20070918000421 |
| Provider Name | Martin A Makela |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114992302 PECOS PAC ID: 3870567118 Enrollment ID: I20071106000370 |
| Provider Name | Kathleen Marie Errico |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588699102 PECOS PAC ID: 5294816393 Enrollment ID: I20080115000353 |
| Provider Name | Fiona E Gallahue |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578503561 PECOS PAC ID: 9032291737 Enrollment ID: I20080204000409 |
| Provider Name | Adeyinka A Adedipe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942272984 PECOS PAC ID: 0446294847 Enrollment ID: I20080313000717 |
| Provider Name | Charles J Oh |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1932377348 PECOS PAC ID: 0042396376 Enrollment ID: I20080326000599 |
| Provider Name | Elyse M Wilson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1164692661 PECOS PAC ID: 9436236007 Enrollment ID: I20080407000335 |
| Provider Name | Joel B Epstein |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1083729131 PECOS PAC ID: 5496716169 Enrollment ID: I20080415000802 |
| Provider Name | Stephen F Dostal |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1679622575 PECOS PAC ID: 6800898941 Enrollment ID: I20080425000383 |
| Provider Name | Matthew J Beecroft |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487825782 PECOS PAC ID: 4587736541 Enrollment ID: I20080708000452 |
| Provider Name | Benjamin Genesuk Seo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922117027 PECOS PAC ID: 3274606199 Enrollment ID: I20080724000611 |
| Provider Name | Theresa Van Der Vlugt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871545855 PECOS PAC ID: 0840280541 Enrollment ID: I20080818000781 |
| Provider Name | Michele M Dostal |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1972529030 PECOS PAC ID: 9830184373 Enrollment ID: I20080819000210 |
| Provider Name | Debra S Johnson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1023264223 PECOS PAC ID: 6305904871 Enrollment ID: I20081028000282 |
| Provider Name | Pamela A Kean |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1326297714 PECOS PAC ID: 6002975398 Enrollment ID: I20081031000062 |
| Provider Name | Richard B Utarnachitt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720292196 PECOS PAC ID: 1850482308 Enrollment ID: I20081106000864 |
| Provider Name | Tiffany K Stanley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629119532 PECOS PAC ID: 1052471034 Enrollment ID: I20081120000492 |
| Provider Name | Stuart Taylor |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790936730 PECOS PAC ID: 0244390201 Enrollment ID: I20081203000837 |
| Provider Name | Eric R Martinez |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1023295615 PECOS PAC ID: 7113074709 Enrollment ID: I20090420000043 |
| Provider Name | Susan A Stern |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679503676 PECOS PAC ID: 5092878520 Enrollment ID: I20090610000108 |
| Provider Name | Timothy Zisman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1427213461 PECOS PAC ID: 8729131354 Enrollment ID: I20090729000978 |
| Provider Name | Elan C Keehn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366696718 PECOS PAC ID: 2567516875 Enrollment ID: I20090821000103 |
| Provider Name | Jasjit K Dillon |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1750413209 PECOS PAC ID: 1557416690 Enrollment ID: I20090826000164 |
| Provider Name | Justin L Speyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457590689 PECOS PAC ID: 0446397079 Enrollment ID: I20091029000709 |
| Provider Name | Shoba Krishnamurthy |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1235128943 PECOS PAC ID: 9739227752 Enrollment ID: I20091112000245 |
| Provider Name | Jennifer E Koukoumidis |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1679802862 PECOS PAC ID: 7810031937 Enrollment ID: I20100212000360 |
| Provider Name | Jared N Strote |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043395866 PECOS PAC ID: 0446385280 Enrollment ID: I20100317001062 |
| Provider Name | Judith Lynn Johnston |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1518297605 PECOS PAC ID: 1052447489 Enrollment ID: I20100324001210 |
| Provider Name | Scott D Lee |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1316022122 PECOS PAC ID: 0042347718 Enrollment ID: I20100429000024 |
| Provider Name | Michelle R Mccausland |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1861723819 PECOS PAC ID: 7416085808 Enrollment ID: I20100505000547 |
| Provider Name | Nhu-quynh N Le |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1851526214 PECOS PAC ID: 0446389969 Enrollment ID: I20100521000324 |
| Provider Name | Jonathan S Ilgen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457441719 PECOS PAC ID: 0345310926 Enrollment ID: I20100609000634 |
| Provider Name | Christopher Brian Behrens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982780789 PECOS PAC ID: 5597896910 Enrollment ID: I20100629000749 |
| Provider Name | Kathleen A Jobe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487744348 PECOS PAC ID: 6800927146 Enrollment ID: I20100630000070 |
| Provider Name | Nathan J White |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205840048 PECOS PAC ID: 1254339013 Enrollment ID: I20100817000004 |
| Provider Name | Cara Jo Langeland |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1174834907 PECOS PAC ID: 1456475904 Enrollment ID: I20100903000978 |
| Provider Name | Philip E Moberg |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1972745230 PECOS PAC ID: 2365566817 Enrollment ID: I20100903000979 |
| Provider Name | Connie A Walton-hoskinson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1740593524 PECOS PAC ID: 6305961053 Enrollment ID: I20100917000633 |
| Provider Name | Lori Ann Dunley |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1487749735 PECOS PAC ID: 1850416462 Enrollment ID: I20100918000271 |
| Provider Name | Heidemarie Poeschla |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1205807567 PECOS PAC ID: 4486770708 Enrollment ID: I20100923001329 |
| Provider Name | Laura E Fife |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871715102 PECOS PAC ID: 0446376297 Enrollment ID: I20100929000700 |
| Provider Name | James Edward Erdman |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1770537391 PECOS PAC ID: 3274725197 Enrollment ID: I20101011001139 |
| Provider Name | Tina Allen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114980117 PECOS PAC ID: 7719170273 Enrollment ID: I20101018000558 |
| Provider Name | Ilia M Sahari |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396982997 PECOS PAC ID: 7517153877 Enrollment ID: I20101129000437 |
| Provider Name | Gustavo Pena |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1649573056 PECOS PAC ID: 5698954659 Enrollment ID: I20110121000935 |
| Provider Name | Tracy D Baxter |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1467690008 PECOS PAC ID: 0547391914 Enrollment ID: I20110321000500 |
| Provider Name | Sachita Shah |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255420733 PECOS PAC ID: 5698815967 Enrollment ID: I20110401000111 |
| Provider Name | Lisa M Cooper |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609834084 PECOS PAC ID: 1759322126 Enrollment ID: I20110401000684 |
| Provider Name | Elizabeth D Rosenman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821257361 PECOS PAC ID: 5092990689 Enrollment ID: I20110425000827 |
| Provider Name | Sau Mui Chan Goh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447589916 PECOS PAC ID: 7214112218 Enrollment ID: I20110505000650 |
| Provider Name | Heemun Kwok |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487628434 PECOS PAC ID: 9032167770 Enrollment ID: I20110601000939 |
| Provider Name | Shane Jay Tosihiro Ruter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255533428 PECOS PAC ID: 6507043296 Enrollment ID: I20110606000746 |
| Provider Name | Herbert C Duber |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497951313 PECOS PAC ID: 1658449046 Enrollment ID: I20110623000664 |
| Provider Name | Megan A Shaw |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1366608143 PECOS PAC ID: 4880862689 Enrollment ID: I20110721000842 |
| Provider Name | Stephen C Morris |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366690927 PECOS PAC ID: 1456403880 Enrollment ID: I20110722000718 |
| Provider Name | Andrew G Ayars |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1336286608 PECOS PAC ID: 5597933135 Enrollment ID: I20110726000253 |
| Provider Name | Jennifer R Tanguay |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1114132388 PECOS PAC ID: 8325217193 Enrollment ID: I20110811000711 |
| Provider Name | Alec J Moorman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1407967722 PECOS PAC ID: 8921277575 Enrollment ID: I20110816000458 |
| Provider Name | Rosemarie Fernandez |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366402240 PECOS PAC ID: 8325022155 Enrollment ID: I20110913000721 |
| Provider Name | Benjaman J Gilham |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1548548126 PECOS PAC ID: 8628249315 Enrollment ID: I20110929000705 |
| Provider Name | Courtney M Weaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740562420 PECOS PAC ID: 5991979692 Enrollment ID: I20111115000275 |
| Provider Name | Diane L Britt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013967975 PECOS PAC ID: 5698940013 Enrollment ID: I20111214000416 |
| Provider Name | Tracy L Fowler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063431641 PECOS PAC ID: 9931376092 Enrollment ID: I20120113000180 |
| Provider Name | Amit Raj Trivedi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821019811 PECOS PAC ID: 3173568698 Enrollment ID: I20120208000793 |
| Provider Name | Katherine R Scherling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760751150 PECOS PAC ID: 5395905806 Enrollment ID: I20120320000986 |
| Provider Name | Esther E Durussel |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1902822554 PECOS PAC ID: 5193719805 Enrollment ID: I20120330000018 |
| Provider Name | Jennifer Fesinmeyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992975569 PECOS PAC ID: 4981864857 Enrollment ID: I20120330000086 |
| Provider Name | Michelle Quinn |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1073882379 PECOS PAC ID: 2860654225 Enrollment ID: I20120501000180 |
| Provider Name | Michael R Sayre |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235210006 PECOS PAC ID: 2668365818 Enrollment ID: I20120525000574 |
| Provider Name | Lauren Kirsten Whiteside |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013034685 PECOS PAC ID: 2668666983 Enrollment ID: I20120612000472 |
| Provider Name | Alison L North |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1205915790 PECOS PAC ID: 3476717943 Enrollment ID: I20120613000180 |
| Provider Name | Taketo Watase |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568666428 PECOS PAC ID: 6608908611 Enrollment ID: I20120613000321 |
| Provider Name | Jason D Heiner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609060623 PECOS PAC ID: 6103082516 Enrollment ID: I20120730000081 |
| Provider Name | Catherine Small |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1598082323 PECOS PAC ID: 4486779881 Enrollment ID: I20120820000317 |
| Provider Name | Matthew J Valento |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487855359 PECOS PAC ID: 9638244023 Enrollment ID: I20120925000185 |
| Provider Name | Margaret D Eugenio |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1477661916 PECOS PAC ID: 6406006923 Enrollment ID: I20121018000508 |
| Provider Name | Peggy P Lee |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1942423983 PECOS PAC ID: 4789834797 Enrollment ID: I20121029000757 |
| Provider Name | Shannon P Rivard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164774808 PECOS PAC ID: 8325290224 Enrollment ID: I20121128000250 |
| Provider Name | Monika D Guzikowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942483672 PECOS PAC ID: 2466699467 Enrollment ID: I20130510000574 |
| Provider Name | Leslie F Graham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669577714 PECOS PAC ID: 6608018247 Enrollment ID: I20130812000635 |
| Provider Name | Jasmine K Zia |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1093826257 PECOS PAC ID: 2264674639 Enrollment ID: I20130814000551 |
| Provider Name | Mark D Derleth |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1356457063 PECOS PAC ID: 2961636162 Enrollment ID: I20131001000258 |
| Provider Name | Thomas B Dodson |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1629050653 PECOS PAC ID: 9436133246 Enrollment ID: I20131002000324 |
| Provider Name | Lisa Rickard Mancl |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1962424416 PECOS PAC ID: 8628202728 Enrollment ID: I20131003000099 |
| Provider Name | Tina Diane Worman |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1962420893 PECOS PAC ID: 0143454249 Enrollment ID: I20131003000128 |
| Provider Name | Lynda A Parton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235561994 PECOS PAC ID: 6608000419 Enrollment ID: I20131010001185 |
| Provider Name | Kevin Leroy Kiemele |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1962420877 PECOS PAC ID: 1759510878 Enrollment ID: I20140212000269 |
| Provider Name | Nicole Anna Kieffer |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1689854853 PECOS PAC ID: 1951451947 Enrollment ID: I20140707001655 |
| Provider Name | Connie Y. K. Au |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538264932 PECOS PAC ID: 7517182215 Enrollment ID: I20140714002456 |
| Provider Name | Kendra M Koeplin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871613406 PECOS PAC ID: 6103042775 Enrollment ID: I20140717001721 |
| Provider Name | Ruth M Foster-koth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689835712 PECOS PAC ID: 2062632045 Enrollment ID: I20140926000439 |
| Provider Name | David R Dean |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790099091 PECOS PAC ID: 7012138878 Enrollment ID: I20141020001055 |
| Provider Name | Karen Marie Manookin |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1740449255 PECOS PAC ID: 9436473212 Enrollment ID: I20150127001474 |
| Provider Name | Srinivasa Chandra |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1538303144 PECOS PAC ID: 9537309216 Enrollment ID: I20150306002298 |
| Provider Name | Dustin W Blevins |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699166785 PECOS PAC ID: 0749508810 Enrollment ID: I20150422000011 |
| Provider Name | Yuli S Mccann |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1619169729 PECOS PAC ID: 6709191695 Enrollment ID: I20150821013174 |
| Provider Name | Daniel Kim |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1811131212 PECOS PAC ID: 2264748953 Enrollment ID: I20150825005698 |
| Provider Name | Allison Marie Fairbanks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245644269 PECOS PAC ID: 1153637053 Enrollment ID: I20150908001198 |
| Provider Name | Anders Theodore Peck |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1811126477 PECOS PAC ID: 0244555464 Enrollment ID: I20150923000132 |
| Provider Name | Mehdi B Matin |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1487965828 PECOS PAC ID: 2365769114 Enrollment ID: I20160816002319 |
| Provider Name | Brittany T Dean |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1871868828 PECOS PAC ID: 9830315514 Enrollment ID: I20160916000972 |
| Provider Name | Samira A Farah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578900213 PECOS PAC ID: 9537315346 Enrollment ID: I20160926000612 |
| Provider Name | Jacqueline J Wong |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1417315490 PECOS PAC ID: 3375830755 Enrollment ID: I20160928002606 |
| Provider Name | Andrea B Burke |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1902097025 PECOS PAC ID: 8921252040 Enrollment ID: I20170217001261 |
| Provider Name | Holly Johanna Bridges |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1821464009 PECOS PAC ID: 1355628769 Enrollment ID: I20170511000933 |
| Provider Name | Rania Abasaeed |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1518346949 PECOS PAC ID: 9032481403 Enrollment ID: I20170818002517 |
| Provider Name | Rashmi Malhotra |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1043668395 PECOS PAC ID: 5597038430 Enrollment ID: I20170829001691 |
| Provider Name | Petros Grivas |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1740443852 PECOS PAC ID: 7012151517 Enrollment ID: I20171211001360 |
| Provider Name | Noam Edward Kopmar |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1902292774 PECOS PAC ID: 9830409085 Enrollment ID: I20180604002136 |
| Provider Name | Ruchi Kapoor |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1225471766 PECOS PAC ID: 2365745007 Enrollment ID: I20190807001969 |
| Provider Name | Anna Lang |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1235556432 PECOS PAC ID: 0244520351 Enrollment ID: I20190821004219 |
| Provider Name | Lauren Y Kawaguchi |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1376193805 PECOS PAC ID: 2860824794 Enrollment ID: I20191114003472 |
| Provider Name | Niveditha Venkatesh |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1487065736 PECOS PAC ID: 4789014663 Enrollment ID: I20200416000892 |
| Provider Name | Whitney Anne Hellyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720454739 PECOS PAC ID: 1759709967 Enrollment ID: I20200918001895 |
| Provider Name | Austin J Gaal |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1366867285 PECOS PAC ID: 5092021626 Enrollment ID: I20201013002457 |
| Provider Name | Nicholas R Sotak |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1629345558 PECOS PAC ID: 1759701519 Enrollment ID: I20201015002492 |
| Provider Name | Garrett Christian Hebel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477028843 PECOS PAC ID: 7416364690 Enrollment ID: I20210406001374 |
| Provider Name | Isabel Angela Hujoel |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1235518465 PECOS PAC ID: 6608187307 Enrollment ID: I20210615003160 |
| Provider Name | Neel Patel |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1629390109 PECOS PAC ID: 1951608744 Enrollment ID: I20211027002313 |
| Provider Name | Andrew Kyle Nalley |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1629425301 PECOS PAC ID: 7810265857 Enrollment ID: I20211210002122 |
| Provider Name | Rashmi Mishra |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053982280 PECOS PAC ID: 7315338951 Enrollment ID: I20211215002300 |
| Provider Name | Alan James Sutton |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1811984339 PECOS PAC ID: 0345653945 Enrollment ID: I20211215002711 |
| Provider Name | Jan Madoka Hyono |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1164852463 PECOS PAC ID: 4183015548 Enrollment ID: I20211220002573 |
| Provider Name | Anne Elizabeth Harvey |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1467939108 PECOS PAC ID: 9436496957 Enrollment ID: I20211221002038 |
| Provider Name | Lorena R Abenojar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457018517 PECOS PAC ID: 6204220825 Enrollment ID: I20220224002593 |
| Provider Name | Matthew Ryskalczyk |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1023451655 PECOS PAC ID: 3577793777 Enrollment ID: I20220310000931 |
| Provider Name | Gale Ann Sebastian Lnu |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1699412569 PECOS PAC ID: 5597145326 Enrollment ID: I20220711000777 |
| Provider Name | Jing Yi Sun |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1073047130 PECOS PAC ID: 8628346004 Enrollment ID: I20220823003988 |
| Provider Name | Angel Dawson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285818500 PECOS PAC ID: 4880078039 Enrollment ID: I20220907001985 |
| Provider Name | Matthew Garrett Gockel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417327628 PECOS PAC ID: 2163899246 Enrollment ID: I20221102000937 |
| Provider Name | Emily Jean Ball |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1609590819 PECOS PAC ID: 5991173924 Enrollment ID: I20221123002047 |
| Provider Name | Laura Jo Flanigan |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1083176010 PECOS PAC ID: 1153664438 Enrollment ID: I20221207002887 |
| Provider Name | Kristie Volmink |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831867746 PECOS PAC ID: 2860882693 Enrollment ID: I20221228000597 |
| Provider Name | Danielle Kirkey |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1134582364 PECOS PAC ID: 3870827389 Enrollment ID: I20230310001188 |
| Provider Name | Beth S. Gendler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952449183 PECOS PAC ID: 6507230653 Enrollment ID: I20230313002693 |
| Provider Name | Julian James Chavez-gamez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255991154 PECOS PAC ID: 4587038195 Enrollment ID: I20230322002075 |
| Provider Name | Zahid S Lalani |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1396748299 PECOS PAC ID: 8527037910 Enrollment ID: I20230412003021 |
| Provider Name | Milda Chmieliauskaite |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1720493265 PECOS PAC ID: 1658641766 Enrollment ID: I20230420000779 |
| Provider Name | Carlene M. Deits-lebehn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467178145 PECOS PAC ID: 5890151799 Enrollment ID: I20230518003690 |
| Provider Name | Brooke Lynne Fitterer |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750415774 PECOS PAC ID: 7618336744 Enrollment ID: I20230706003593 |
| Provider Name | Rachel Chisausky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134765910 PECOS PAC ID: 0840615381 Enrollment ID: I20230714000567 |
| Provider Name | Katherine Walukevich Dienst |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447947270 PECOS PAC ID: 1658731948 Enrollment ID: I20230718003360 |
| Provider Name | Austin W Kollefrath |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578126058 PECOS PAC ID: 4183958549 Enrollment ID: I20230728002917 |
| Provider Name | Stacey Ma |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1184155202 PECOS PAC ID: 0446529812 Enrollment ID: I20230731003422 |
| Provider Name | Daniel Winthrop Fisher |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740727734 PECOS PAC ID: 7810359593 Enrollment ID: I20230811001396 |
| Provider Name | Laura E. Escalona-flores |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073751103 PECOS PAC ID: 6608230198 Enrollment ID: I20230918001106 |
| Provider Name | Heather Julieta Diaz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477039139 PECOS PAC ID: 8123472230 Enrollment ID: I20230922003143 |
| Provider Name | Ina Virginia Emmanuel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104126192 PECOS PAC ID: 8123473162 Enrollment ID: I20231011004018 |
| Provider Name | Lynn M. Elwood |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235254251 PECOS PAC ID: 0840641916 Enrollment ID: I20240112003086 |
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