| Whiteriver Indian Hospital | |
|
200 West Hospital Drive Whiteriver AZ 85941-0860 | |
| (928) 338-4911 | |
| (928) 338-5508 |
| Full Name | Whiteriver Indian Hospital |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 200 West Hospital Drive, Whiteriver, Arizona |
| Authorized Official Name and Position | Michelle Martinez (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9283384911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Whiteriver Indian Hospital 200 West Hospital Drive P.o. Box 860 Whiteriver AZ 85941-0860 Ph: (928) 338-4911 | Whiteriver Indian Hospital 200 West Hospital Drive Whiteriver AZ 85941-0860 Ph: (928) 338-4911 |
| NPI Number | 1427335140 |
|---|---|
| Provider Enumeration Date | 11/09/2011 |
| Last Update Date | 11/27/2013 |
| Medicare PECOS PAC ID | 2668649567 |
|---|---|
| Medicare Enrollment ID | O20120117000781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427335140 | NPI | - | NPPES |
| 092403 | Other | AZ | MEDICAID DENTAL |
| 020561 | Medicaid | AZ |
| Provider Name | Eric A Brody |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730290172 PECOS PAC ID: 0345132171 Enrollment ID: I20040326000884 |
| Provider Name | Sandeep Nirmal Amesur |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144329848 PECOS PAC ID: 8921990870 Enrollment ID: I20040729001520 |
| Provider Name | Eva M Prakash |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528048774 PECOS PAC ID: 1254396781 Enrollment ID: I20041124000222 |
| Provider Name | Gregory T Jarrin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1275663197 PECOS PAC ID: 5698723658 Enrollment ID: I20050106000092 |
| Provider Name | Wendy L Monrad |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1134186810 PECOS PAC ID: 3971576943 Enrollment ID: I20050420001287 |
| Provider Name | Lisa M Sumner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962512012 PECOS PAC ID: 4284675182 Enrollment ID: I20050520000756 |
| Provider Name | Scott A Hamstra |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356421382 PECOS PAC ID: 0446283659 Enrollment ID: I20050916000622 |
| Provider Name | Yuming Yin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972586543 PECOS PAC ID: 6507820107 Enrollment ID: I20051028000785 |
| Provider Name | Robert J Wylie |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1568436871 PECOS PAC ID: 4082632187 Enrollment ID: I20060111000465 |
| Provider Name | Gerald D Spinner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548277858 PECOS PAC ID: 3779507975 Enrollment ID: I20060113000760 |
| Provider Name | Amanda K Swallow |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1265452130 PECOS PAC ID: 7416967294 Enrollment ID: I20060424000331 |
| Provider Name | Gregory W Hann |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1861567968 PECOS PAC ID: 8921008160 Enrollment ID: I20070111000278 |
| Provider Name | Scott P Gaustad |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063547222 PECOS PAC ID: 5294836631 Enrollment ID: I20070728000293 |
| Provider Name | David J Abbott |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1881891257 PECOS PAC ID: 8527159912 Enrollment ID: I20070814000859 |
| Provider Name | Ewane Ngone |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770554446 PECOS PAC ID: 9830094853 Enrollment ID: I20071031000623 |
| Provider Name | Mark W Kleve |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578600045 PECOS PAC ID: 9638250079 Enrollment ID: I20080111000272 |
| Provider Name | Jon C Stucki |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235236126 PECOS PAC ID: 5890876841 Enrollment ID: I20080115000738 |
| Provider Name | Karen L Bramer-fortier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003095811 PECOS PAC ID: 1456432046 Enrollment ID: I20080122000324 |
| Provider Name | James Brull |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457313413 PECOS PAC ID: 0446245153 Enrollment ID: I20080305000527 |
| Provider Name | Dino R Dominguez |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1629052436 PECOS PAC ID: 1557360138 Enrollment ID: I20080923000231 |
| Provider Name | Kenneth Tan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306008834 PECOS PAC ID: 1153485438 Enrollment ID: I20090202000071 |
| Provider Name | Monica L Faley |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1023171824 PECOS PAC ID: 2567532278 Enrollment ID: I20090331000454 |
| Provider Name | Daria B Lee |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1235199613 PECOS PAC ID: 5092731893 Enrollment ID: I20090820000781 |
| Provider Name | Stephen M Melnychuk |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255598611 PECOS PAC ID: 1153477146 Enrollment ID: I20090916000245 |
| Provider Name | Scott D Mcgrew |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1427281161 PECOS PAC ID: 5991851727 Enrollment ID: I20090921000502 |
| Provider Name | Kenneth Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841311586 PECOS PAC ID: 4880730381 Enrollment ID: I20091014000572 |
| Provider Name | William J Waldo |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1497725014 PECOS PAC ID: 3870630684 Enrollment ID: I20091028000145 |
| Provider Name | Tami A Bonebrake |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144252032 PECOS PAC ID: 1951396787 Enrollment ID: I20091103000150 |
| Provider Name | Matthew K Rydberg |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649285446 PECOS PAC ID: 2163560319 Enrollment ID: I20091110000155 |
| Provider Name | Robinder K Bhangoo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073533543 PECOS PAC ID: 7113981333 Enrollment ID: I20100218000062 |
| Provider Name | Andrea Woolridge |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1235208919 PECOS PAC ID: 1658415245 Enrollment ID: I20100220000026 |
| Provider Name | Judy S Lee-norris |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1881618262 PECOS PAC ID: 9931104627 Enrollment ID: I20100302000637 |
| Provider Name | Manuel Fachado |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1740228394 PECOS PAC ID: 2062426448 Enrollment ID: I20100308000240 |
| Provider Name | Elizabeth A Boot |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972662724 PECOS PAC ID: 7214062124 Enrollment ID: I20100317000703 |
| Provider Name | R Michael Harding |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780616243 PECOS PAC ID: 6709885056 Enrollment ID: I20100512000300 |
| Provider Name | Patrick D Lynch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205842903 PECOS PAC ID: 7214823731 Enrollment ID: I20101012000861 |
| Provider Name | Judith E Pentz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700926334 PECOS PAC ID: 4082696117 Enrollment ID: I20101210000036 |
| Provider Name | Carolyn Joyce Kenyon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154366797 PECOS PAC ID: 4486555653 Enrollment ID: I20110112000074 |
| Provider Name | Janelle E Brown |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831105998 PECOS PAC ID: 9234318015 Enrollment ID: I20110126000067 |
| Provider Name | Matthew G Cusick |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1275743270 PECOS PAC ID: 2567517642 Enrollment ID: I20110217000567 |
| Provider Name | Angela Giampaolo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720205479 PECOS PAC ID: 2769668714 Enrollment ID: I20110509000861 |
| Provider Name | Terrence Cavanaugh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881674695 PECOS PAC ID: 5991764920 Enrollment ID: I20110512000675 |
| Provider Name | Grant S Berges |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447380977 PECOS PAC ID: 9830296565 Enrollment ID: I20110524000538 |
| Provider Name | Kenneth A Giles |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972583797 PECOS PAC ID: 1456394048 Enrollment ID: I20110524000584 |
| Provider Name | Kristie C Harris |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417940420 PECOS PAC ID: 0244278208 Enrollment ID: I20110603000146 |
| Provider Name | James E Zelichowski |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1992869093 PECOS PAC ID: 4385815919 Enrollment ID: I20110912000447 |
| Provider Name | Michelle Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407972532 PECOS PAC ID: 4284781881 Enrollment ID: I20111116000403 |
| Provider Name | Dianna L Mahoney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649372004 PECOS PAC ID: 4486828050 Enrollment ID: I20111116000418 |
| Provider Name | John K Bratsch |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1629093760 PECOS PAC ID: 7517131832 Enrollment ID: I20111123000492 |
| Provider Name | Susan C Vest |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972692028 PECOS PAC ID: 0244404382 Enrollment ID: I20111129000550 |
| Provider Name | Marc S Traeger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639185739 PECOS PAC ID: 7618142563 Enrollment ID: I20111205000862 |
| Provider Name | Robert A Hill |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124063177 PECOS PAC ID: 9537162888 Enrollment ID: I20111221000140 |
| Provider Name | Elizabeth C Clark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922014182 PECOS PAC ID: 5597932756 Enrollment ID: I20120111000864 |
| Provider Name | Richard J Robinson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1073529145 PECOS PAC ID: 2668634106 Enrollment ID: I20120430000665 |
| Provider Name | David A Yost |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225044399 PECOS PAC ID: 2860469871 Enrollment ID: I20120508000545 |
| Provider Name | Jeffrey S Izenberg |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1285670984 PECOS PAC ID: 8123047487 Enrollment ID: I20120611000060 |
| Provider Name | Polly J Logan |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1215063987 PECOS PAC ID: 9638334063 Enrollment ID: I20120709000659 |
| Provider Name | Ayesha Khalil |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1437407160 PECOS PAC ID: 7315197043 Enrollment ID: I20121015000664 |
| Provider Name | Christopher K Jentoft |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003040940 PECOS PAC ID: 5698929750 Enrollment ID: I20130126000003 |
| Provider Name | Cheryl D Scaff |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1801231345 PECOS PAC ID: 4981848470 Enrollment ID: I20130924000418 |
| Provider Name | David K Bass |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225076219 PECOS PAC ID: 8921912411 Enrollment ID: I20131022001178 |
| Provider Name | Charles A Schmier |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598983793 PECOS PAC ID: 9830240050 Enrollment ID: I20131025000368 |
| Provider Name | Joan M Kohr |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1376518688 PECOS PAC ID: 0941226724 Enrollment ID: I20131029001616 |
| Provider Name | Lenorah A Wos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639339005 PECOS PAC ID: 1052548336 Enrollment ID: I20131211001631 |
| Provider Name | Lisa Ann Young |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043446222 PECOS PAC ID: 8426205139 Enrollment ID: I20140129000606 |
| Provider Name | William W Phillips |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184634628 PECOS PAC ID: 1052351533 Enrollment ID: I20140512000482 |
| Provider Name | Qazi F Uddin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609180306 PECOS PAC ID: 3577713874 Enrollment ID: I20140529000046 |
| Provider Name | Harry H Ahn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730492000 PECOS PAC ID: 6709000847 Enrollment ID: I20140612000345 |
| Provider Name | Rhoda Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053503540 PECOS PAC ID: 1658456140 Enrollment ID: I20140709000451 |
| Provider Name | Manjunath Shivamanya Kottalgi |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1497082432 PECOS PAC ID: 6608099254 Enrollment ID: I20140721001019 |
| Provider Name | Ashley J Randall |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1689080582 PECOS PAC ID: 2668698598 Enrollment ID: I20140729001773 |
| Provider Name | Jennifer L Himmelstein |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1669888525 PECOS PAC ID: 7810113776 Enrollment ID: I20140729002670 |
| Provider Name | James G Ard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104895242 PECOS PAC ID: 8123213295 Enrollment ID: I20140815001213 |
| Provider Name | Troy A Belle |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629031299 PECOS PAC ID: 1658308150 Enrollment ID: I20140826000759 |
| Provider Name | Nadia L Norton Anspach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699060889 PECOS PAC ID: 5496973828 Enrollment ID: I20140827001446 |
| Provider Name | James Yc Tang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508151127 PECOS PAC ID: 8022238468 Enrollment ID: I20141216001326 |
| Provider Name | Lance Mcadams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497089205 PECOS PAC ID: 5991028730 Enrollment ID: I20141230002145 |
| Provider Name | Kristi A Petersen |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1548515406 PECOS PAC ID: 2365671583 Enrollment ID: I20150102000288 |
| Provider Name | Nargiz Ruzmetova |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700047396 PECOS PAC ID: 9436309713 Enrollment ID: I20150113000360 |
| Provider Name | Bradley Power |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1609277367 PECOS PAC ID: 0749504066 Enrollment ID: I20150115000332 |
| Provider Name | Regina M Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912995010 PECOS PAC ID: 2264427509 Enrollment ID: I20150219000943 |
| Provider Name | Lisa Devine Coughlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487090627 PECOS PAC ID: 6103144746 Enrollment ID: I20150413000277 |
| Provider Name | Lydia Zhang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235243346 PECOS PAC ID: 5991754244 Enrollment ID: I20150416002060 |
| Provider Name | Latania C Sci |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033266937 PECOS PAC ID: 8224124359 Enrollment ID: I20150421002271 |
| Provider Name | Suarna Mehulic |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023248762 PECOS PAC ID: 6608195219 Enrollment ID: I20150504001137 |
| Provider Name | Zhanna Albany |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861654220 PECOS PAC ID: 7012186935 Enrollment ID: I20150608000202 |
| Provider Name | Jae Dell M Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215361787 PECOS PAC ID: 8123349610 Enrollment ID: I20150609002469 |
| Provider Name | Andrew J Gusty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790763175 PECOS PAC ID: 9537184387 Enrollment ID: I20150831001430 |
| Provider Name | Ellen Rodriguez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952397978 PECOS PAC ID: 8224206222 Enrollment ID: I20150915001131 |
| Provider Name | Charles William Miles |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588645683 PECOS PAC ID: 9638363138 Enrollment ID: I20151006001597 |
| Provider Name | Rachelle R Miles |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639431877 PECOS PAC ID: 1254655095 Enrollment ID: I20151015000787 |
| Provider Name | Rebecca M Mcsorley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538435508 PECOS PAC ID: 6608093539 Enrollment ID: I20151026000268 |
| Provider Name | Megan A Krispinsky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346534989 PECOS PAC ID: 8729215033 Enrollment ID: I20151029001209 |
| Provider Name | Dominick G Maggio |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679848501 PECOS PAC ID: 6709000987 Enrollment ID: I20151029002033 |
| Provider Name | Vangie P Ramos |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1417061847 PECOS PAC ID: 3779883186 Enrollment ID: I20151207002273 |
| Provider Name | Amy C Madril |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578513537 PECOS PAC ID: 0345294229 Enrollment ID: I20160203002179 |
| Provider Name | Lynne Brownell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679615140 PECOS PAC ID: 9931256336 Enrollment ID: I20160223000056 |
| Provider Name | Aracelio Diaz Perez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1447697511 PECOS PAC ID: 1052620598 Enrollment ID: I20160223000434 |
| Provider Name | Michael Wasowicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922407063 PECOS PAC ID: 9931320264 Enrollment ID: I20160405000420 |
| Provider Name | Harbhajan Singh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225025760 PECOS PAC ID: 2668409806 Enrollment ID: I20160413001036 |
| Provider Name | Vance P Hoopes |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831472729 PECOS PAC ID: 2668631607 Enrollment ID: I20160414000689 |
| Provider Name | Arnold Finkleman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053371542 PECOS PAC ID: 0941196307 Enrollment ID: I20160503000507 |
| Provider Name | James Mcauley |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1669407037 PECOS PAC ID: 0446260939 Enrollment ID: I20160613001798 |
| Provider Name | Amy E Mcauley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730134024 PECOS PAC ID: 3375836562 Enrollment ID: I20160726001415 |
| Provider Name | Charles M Calvo |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1194087940 PECOS PAC ID: 0840421962 Enrollment ID: I20160809000581 |
| Provider Name | Naomi H Hixson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1841591096 PECOS PAC ID: 1355635210 Enrollment ID: I20160816001020 |
| Provider Name | John I Young |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1114218963 PECOS PAC ID: 7618114729 Enrollment ID: I20160816002390 |
| Provider Name | Michael E Rush |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053367656 PECOS PAC ID: 7618959123 Enrollment ID: I20160829000885 |
| Provider Name | Salman Arif |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225404528 PECOS PAC ID: 8921393794 Enrollment ID: I20161004001920 |
| Provider Name | Brant E Kirk |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1477843605 PECOS PAC ID: 0749578912 Enrollment ID: I20161004002562 |
| Provider Name | Carl G Lindquist |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073565255 PECOS PAC ID: 6305996315 Enrollment ID: I20161111000206 |
| Provider Name | Ryan Close |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831451442 PECOS PAC ID: 0446540686 Enrollment ID: I20161220001641 |
| Provider Name | Laura M Close |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770039059 PECOS PAC ID: 3971884446 Enrollment ID: I20161222000123 |
| Provider Name | Michael D Berven |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871816694 PECOS PAC ID: 5799084547 Enrollment ID: I20170106000685 |
| Provider Name | Nelson Ayala Rubio |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1326220211 PECOS PAC ID: 7315017803 Enrollment ID: I20170121000110 |
| Provider Name | Daniel R Johnson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1780090761 PECOS PAC ID: 4587958574 Enrollment ID: I20170215003062 |
| Provider Name | Richard A Vinroot |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992807135 PECOS PAC ID: 2264523448 Enrollment ID: I20170315000411 |
| Provider Name | Osmany Duany |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578792412 PECOS PAC ID: 6305083924 Enrollment ID: I20170502002298 |
| Provider Name | Emily M Gaffney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811431612 PECOS PAC ID: 8527335793 Enrollment ID: I20170519000467 |
| Provider Name | Stuart M Shellenberger |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1275893604 PECOS PAC ID: 7214192012 Enrollment ID: I20170609000267 |
| Provider Name | Dyanne V Medina-jarrin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750813754 PECOS PAC ID: 6800173766 Enrollment ID: I20170810002050 |
| Provider Name | Jennifer L Mathis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548304892 PECOS PAC ID: 8426158270 Enrollment ID: I20170816003686 |
| Provider Name | Jared Ryan Lunkenheimer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922418979 PECOS PAC ID: 4789804329 Enrollment ID: I20170818000226 |
| Provider Name | Elvia R Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639621741 PECOS PAC ID: 6901179423 Enrollment ID: I20170906000356 |
| Provider Name | Celine R Gounder |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629104302 PECOS PAC ID: 1153515796 Enrollment ID: I20170913003432 |
| Provider Name | Kimberly M Marr |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1851697742 PECOS PAC ID: 0143594465 Enrollment ID: I20170925001766 |
| Provider Name | Jennifer L Michener |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144665860 PECOS PAC ID: 6406164664 Enrollment ID: I20171005000612 |
| Provider Name | Kathy S Lynch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245483478 PECOS PAC ID: 9032234034 Enrollment ID: I20171010002214 |
| Provider Name | Thomas R Jensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548292436 PECOS PAC ID: 7113941071 Enrollment ID: I20171013001776 |
| Provider Name | Myles Joseph Stone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750794392 PECOS PAC ID: 8628376134 Enrollment ID: I20171016002940 |
| Provider Name | Hailey L Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881006542 PECOS PAC ID: 1759601990 Enrollment ID: I20171122002185 |
| Provider Name | Thomas Zarchary Boone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699188672 PECOS PAC ID: 3476779364 Enrollment ID: I20171127001125 |
| Provider Name | Laura A Jordan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255674362 PECOS PAC ID: 1759678915 Enrollment ID: I20171128000967 |
| Provider Name | Alexander Figueroa Madera |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760890123 PECOS PAC ID: 1557682200 Enrollment ID: I20171130000333 |
| Provider Name | Joseph Van Someren Henderson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639583578 PECOS PAC ID: 6103183058 Enrollment ID: I20171130001672 |
| Provider Name | Scott T Peake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497205819 PECOS PAC ID: 4880952258 Enrollment ID: I20171213002266 |
| Provider Name | Richard D Rossin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518942861 PECOS PAC ID: 5193721017 Enrollment ID: I20171218000923 |
| Provider Name | Jason J Ballew |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235146036 PECOS PAC ID: 4082614409 Enrollment ID: I20180123000840 |
| Provider Name | Evan Tyler Hall |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376835264 PECOS PAC ID: 5698048445 Enrollment ID: I20180208000263 |
| Provider Name | Deepthi R Rao |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1932426731 PECOS PAC ID: 4486891215 Enrollment ID: I20180220002348 |
| Provider Name | Samuel J Rosero Garcia |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1912395807 PECOS PAC ID: 0244506418 Enrollment ID: I20180427000082 |
| Provider Name | Carlos Moreyra |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1790854594 PECOS PAC ID: 7810178712 Enrollment ID: I20180618002355 |
| Provider Name | Juanita I Jalomo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053714360 PECOS PAC ID: 3870840390 Enrollment ID: I20180716000738 |
| Provider Name | James C Haug |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275875973 PECOS PAC ID: 6800147836 Enrollment ID: I20181001002239 |
| Provider Name | Lee Rydberg Ryder |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1841771151 PECOS PAC ID: 3274886338 Enrollment ID: I20181019001606 |
| Provider Name | Hana Bakalli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861887226 PECOS PAC ID: 7113211178 Enrollment ID: I20181023002099 |
| Provider Name | Eben J Clattenburg |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1184994857 PECOS PAC ID: 2466738745 Enrollment ID: I20181026000813 |
| Provider Name | Richard Cobden |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1750396479 PECOS PAC ID: 7618872698 Enrollment ID: I20190116001879 |
| Provider Name | John R Guzek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861460545 PECOS PAC ID: 8921177809 Enrollment ID: I20190219002587 |
| Provider Name | Sarah M Garfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053866475 PECOS PAC ID: 2163705104 Enrollment ID: I20190405000560 |
| Provider Name | Elizabeth A Van Dyne |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1235499161 PECOS PAC ID: 6901050202 Enrollment ID: I20190408000967 |
| Provider Name | Frank S Dowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417917915 PECOS PAC ID: 1254324437 Enrollment ID: I20190501001144 |
| Provider Name | Austin G Acree |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1790245587 PECOS PAC ID: 7315280468 Enrollment ID: I20190514000316 |
| Provider Name | Tamara M Polidore |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1538589395 PECOS PAC ID: 4789800715 Enrollment ID: I20190606000380 |
| Provider Name | Glenn I Sharfin |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1497827919 PECOS PAC ID: 9234151622 Enrollment ID: I20190621002181 |
| Provider Name | Lindsey M Retterath |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417334970 PECOS PAC ID: 3971817925 Enrollment ID: I20190815000673 |
| Provider Name | Jeanne Bohm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982915138 PECOS PAC ID: 0244474948 Enrollment ID: I20190905001818 |
| Provider Name | Soo C Han |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1457779811 PECOS PAC ID: 1658601562 Enrollment ID: I20190919000311 |
| Provider Name | Mark A Bailey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538587365 PECOS PAC ID: 3173742244 Enrollment ID: I20191002001729 |
| Provider Name | Tina M Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871147223 PECOS PAC ID: 1759612823 Enrollment ID: I20191004000713 |
| Provider Name | Dakota P Kay |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1033767371 PECOS PAC ID: 0244561587 Enrollment ID: I20191017000690 |
| Provider Name | Julia L Hellman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760729016 PECOS PAC ID: 5092077891 Enrollment ID: I20191226000838 |
| Provider Name | Braden K Jones |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1437596103 PECOS PAC ID: 2668615295 Enrollment ID: I20200219001491 |
| Provider Name | Terry D Wood |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1609856426 PECOS PAC ID: 1355332289 Enrollment ID: I20200225000752 |
| Provider Name | Maria A Cornelius |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720314461 PECOS PAC ID: 5395933956 Enrollment ID: I20200417001153 |
| Provider Name | Rachael C Caster |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679918353 PECOS PAC ID: 4981991817 Enrollment ID: I20200424000311 |
| Provider Name | Christian Theodosis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780886952 PECOS PAC ID: 3072694017 Enrollment ID: I20200623001155 |
| Provider Name | Shane C Walker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942720032 PECOS PAC ID: 8628490497 Enrollment ID: I20200624001200 |
| Provider Name | Chase B Warner |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1730543968 PECOS PAC ID: 5698066603 Enrollment ID: I20200924000957 |
| Provider Name | Stephen P Roesler |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1689626160 PECOS PAC ID: 1254343395 Enrollment ID: I20201006001086 |
| Provider Name | Dara E Mendelsohn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487072161 PECOS PAC ID: 4183906860 Enrollment ID: I20201006002642 |
| Provider Name | Ryan E Mccallum |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1538331137 PECOS PAC ID: 9234559600 Enrollment ID: I20201023002111 |
| Provider Name | Bernadyne A Agan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477104842 PECOS PAC ID: 7214357581 Enrollment ID: I20201027000195 |
| Provider Name | Lauren M Sheehy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083004360 PECOS PAC ID: 5698068740 Enrollment ID: I20201105002338 |
| Provider Name | John P Gonzales |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1477679876 PECOS PAC ID: 2769797042 Enrollment ID: I20201124003051 |
| Provider Name | Christopher M Culhane |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447784608 PECOS PAC ID: 2961773551 Enrollment ID: I20201202001608 |
| Provider Name | Richard S Lunt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396050944 PECOS PAC ID: 2062691488 Enrollment ID: I20201203000230 |
| Provider Name | Manda M Palmertree |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1114213170 PECOS PAC ID: 1456522218 Enrollment ID: I20201208002652 |
| Provider Name | Mariko A Nomura |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376977298 PECOS PAC ID: 5698109106 Enrollment ID: I20210223002765 |
| Provider Name | Joseph D Mega |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215280805 PECOS PAC ID: 6901020189 Enrollment ID: I20210224000492 |
| Provider Name | Mckayla R Mashburn |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1235731506 PECOS PAC ID: 5890106041 Enrollment ID: I20210415000097 |
| Provider Name | Charles L Cole |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1174837330 PECOS PAC ID: 9234254988 Enrollment ID: I20210428000152 |
| Provider Name | Rebecca M Stephan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790371094 PECOS PAC ID: 8426467606 Enrollment ID: I20210430000024 |
| Provider Name | Willie L Nunez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689808693 PECOS PAC ID: 5193042174 Enrollment ID: I20210507000501 |
| Provider Name | Nancy S Remington |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1154322568 PECOS PAC ID: 4981623014 Enrollment ID: I20210609000042 |
| Provider Name | James R Lish |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346698040 PECOS PAC ID: 4183032428 Enrollment ID: I20210629002050 |
| Provider Name | Molly P Hallweaver |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134655905 PECOS PAC ID: 9133552441 Enrollment ID: I20210813001267 |
| Provider Name | Daniel W Pitts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831403187 PECOS PAC ID: 6901098961 Enrollment ID: I20210908002416 |
| Provider Name | Aderonke A Oguntoye |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285817551 PECOS PAC ID: 9032369467 Enrollment ID: I20210924000800 |
| Provider Name | Leigh Pemberton Johnson |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1699202085 PECOS PAC ID: 9638449333 Enrollment ID: I20211026003632 |
| Provider Name | Adriana Stewart Gonzales |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568758522 PECOS PAC ID: 2264672542 Enrollment ID: I20211028000103 |
| Provider Name | Ashkan Bahin-aein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508983057 PECOS PAC ID: 6204975030 Enrollment ID: I20211217001541 |
| Provider Name | Joshua S Becasen |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1063177756 PECOS PAC ID: 1052702735 Enrollment ID: I20220107000542 |
| Provider Name | Katherine E Whitney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043584857 PECOS PAC ID: 4284899592 Enrollment ID: I20220209000508 |
| Provider Name | Paula S Cooper-mcqueen |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1164505780 PECOS PAC ID: 5597858050 Enrollment ID: I20220224000678 |
| Provider Name | Farooq M Ishteeaque |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1922084730 PECOS PAC ID: 1850609181 Enrollment ID: I20220519000144 |
| Provider Name | Cj Duncan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114663895 PECOS PAC ID: 9335527050 Enrollment ID: I20220608000248 |
| Provider Name | Justin B Webber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205287141 PECOS PAC ID: 1052658457 Enrollment ID: I20220627002454 |
| Provider Name | Jacob L. Taylor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902198211 PECOS PAC ID: 7315196516 Enrollment ID: I20220901001161 |
| Provider Name | Alexander D W Schmalz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912405267 PECOS PAC ID: 2860826831 Enrollment ID: I20220909000968 |
| Provider Name | Lincoln S Matheson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477905545 PECOS PAC ID: 5294012134 Enrollment ID: I20220926000345 |
| Provider Name | Dishant Shah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497963011 PECOS PAC ID: 4880728187 Enrollment ID: I20221116001394 |
| Provider Name | Benjamin Coleman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1437456589 PECOS PAC ID: 2466691761 Enrollment ID: I20230501000849 |
| Provider Name | Michael D Rose |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194046169 PECOS PAC ID: 4880840446 Enrollment ID: I20230601001142 |
| Provider Name | Jessica S Rose |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1689995664 PECOS PAC ID: 6406004738 Enrollment ID: I20230601002505 |
| Provider Name | Travis Austin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003250440 PECOS PAC ID: 1658678255 Enrollment ID: I20230613001228 |
| Provider Name | Frank Freund |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1952338857 PECOS PAC ID: 5799735916 Enrollment ID: I20230628004219 |
| Provider Name | Elaine Yang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710349485 PECOS PAC ID: 5991035792 Enrollment ID: I20230630001914 |
| Provider Name | Armand Jamal Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851068282 PECOS PAC ID: 6709278211 Enrollment ID: I20230919003064 |
| Provider Name | Katheryn Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083262620 PECOS PAC ID: 0345572459 Enrollment ID: I20231011004143 |
| Provider Name | Sarah Mellberg |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1821773565 PECOS PAC ID: 3476909698 Enrollment ID: I20231025000035 |
| Provider Name | Lisha Murphy |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1376179226 PECOS PAC ID: 2860814357 Enrollment ID: I20231208001862 |
| Provider Name | Daniel M Baker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033193941 PECOS PAC ID: 1850389644 Enrollment ID: I20240216003427 |
| Provider Name | Hannah Y Bae |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770632168 PECOS PAC ID: 4082792676 Enrollment ID: I20240217000258 |
| Provider Name | Robert Berger |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386688851 PECOS PAC ID: 4789574757 Enrollment ID: I20240219000025 |
| Provider Name | Anthony J Willis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972866911 PECOS PAC ID: 4688947120 Enrollment ID: I20240219000122 |
| Provider Name | Kimberly A Taylor |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396772703 PECOS PAC ID: 3870543176 Enrollment ID: I20240219000283 |
| Provider Name | Sanford M Smoot |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720072697 PECOS PAC ID: 6103833488 Enrollment ID: I20240219000358 |
| Provider Name | Shree J Shah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588688782 PECOS PAC ID: 8729086715 Enrollment ID: I20240219000423 |
| Provider Name | Benjamin R Park |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770922676 PECOS PAC ID: 9032451562 Enrollment ID: I20240220001893 |
| Provider Name | Noman A Malik |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003841875 PECOS PAC ID: 7719982321 Enrollment ID: I20240220002362 |
| Provider Name | Christopher S Johnson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1760532634 PECOS PAC ID: 3375629769 Enrollment ID: I20240220002585 |
| Provider Name | William J Rusnak |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366854325 PECOS PAC ID: 9638450943 Enrollment ID: I20240221001131 |
| Provider Name | William T Randazzo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881915346 PECOS PAC ID: 4981918158 Enrollment ID: I20240221001401 |
| Provider Name | Asti Pilika |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043469992 PECOS PAC ID: 6608065222 Enrollment ID: I20240221001990 |
| Provider Name | Corey W Chopra |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528118106 PECOS PAC ID: 2961596499 Enrollment ID: I20240221002709 |
| Provider Name | Dennis Burton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043298417 PECOS PAC ID: 7416857388 Enrollment ID: I20240221003409 |
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