| Ascension Providence Rochester Hospital | |
|
1101 W University Dr Rochester MI 48307-1863 | |
| (248) 652-5000 | |
| Not Available |
| Full Name | Ascension Providence Rochester Hospital |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1101 W University Dr, Rochester, Michigan |
| Authorized Official Name and Position | Jean Jeup (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2486808203 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ascension Providence Rochester Hospital 1101 W University Dr Rochester MI 48307-1863 Ph: (248) 652-5000 | Ascension Providence Rochester Hospital 1101 W University Dr Rochester MI 48307-1863 Ph: (248) 652-5000 |
| NPI Number | 1366565442 |
|---|---|
| Provider Enumeration Date | 04/06/2007 |
| Last Update Date | 08/28/2019 |
| Medicare PECOS PAC ID | 8820994098 |
|---|---|
| Medicare Enrollment ID | O20071117000068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366565442 | NPI | - | NPPES |
| 0F34941 | Other | MI | PROFESSIONAL NEUR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 630070 (Michigan) | Primary |
| Provider Name | Lynn Louise Mathia |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1689672529 PECOS PAC ID: 8426957556 Enrollment ID: I20040107000642 |
| Provider Name | Sheryl Ann Wissman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386642056 PECOS PAC ID: 6608835053 Enrollment ID: I20041012001541 |
| Provider Name | Peter J Korda |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1760564116 PECOS PAC ID: 6406814789 Enrollment ID: I20050103000965 |
| Provider Name | Nada Hana Bachuri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164502555 PECOS PAC ID: 8527087188 Enrollment ID: I20051114000691 |
| Provider Name | John Ernest Lamacchia |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1669465761 PECOS PAC ID: 1951380435 Enrollment ID: I20060120000375 |
| Provider Name | Jeffrey Hilliard Declaire |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1265442446 PECOS PAC ID: 7618986316 Enrollment ID: I20060407000118 |
| Provider Name | Frederick C Rosin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790722338 PECOS PAC ID: 5496767659 Enrollment ID: I20060707000134 |
| Provider Name | Nancy L Mattoni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316020902 PECOS PAC ID: 0446438600 Enrollment ID: I20110617000415 |
| Provider Name | Sarwan Kumar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760772362 PECOS PAC ID: 5799963260 Enrollment ID: I20110705000243 |
| Provider Name | Deborah A Romain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811201114 PECOS PAC ID: 7517123821 Enrollment ID: I20120731000394 |
| Provider Name | Zain Imad Kulairi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1578856456 PECOS PAC ID: 3072736644 Enrollment ID: I20140529000840 |
| Provider Name | Rachel Maryann Klamo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497953533 PECOS PAC ID: 3274689856 Enrollment ID: I20150710001328 |
| Provider Name | Vesna Tegeltija |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538504956 PECOS PAC ID: 0042529901 Enrollment ID: I20151016000946 |
| Provider Name | Ryan J Pradko |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841605888 PECOS PAC ID: 4385957224 Enrollment ID: I20160502001453 |
| Provider Name | Tess Mccready |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093058786 PECOS PAC ID: 0547401416 Enrollment ID: I20160713001372 |
| Provider Name | Adam M Hull |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851719033 PECOS PAC ID: 6800190182 Enrollment ID: I20160812000559 |
| Provider Name | Giacomo P Folden |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1215310073 PECOS PAC ID: 4981917820 Enrollment ID: I20170629001262 |
| Provider Name | Nicholas Frisch |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1093002214 PECOS PAC ID: 7113159815 Enrollment ID: I20171020001437 |
| Provider Name | Heidi B Hilton-kosch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104205301 PECOS PAC ID: 1254645393 Enrollment ID: I20180514002294 |
| Provider Name | Nathan Evin Marshall |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1548529639 PECOS PAC ID: 5799917605 Enrollment ID: I20180628003135 |
| Provider Name | Eleanor R King |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104213867 PECOS PAC ID: 5294037222 Enrollment ID: I20180718001043 |
| Provider Name | Joseph Henry Vercellone |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114374964 PECOS PAC ID: 5890087191 Enrollment ID: I20190625002053 |
| Provider Name | Robert G Dekker |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1023350493 PECOS PAC ID: 7416252234 Enrollment ID: I20190813000334 |
| Provider Name | Andrea Milne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659787000 PECOS PAC ID: 7416381470 Enrollment ID: I20191227001041 |
| Provider Name | Alanna L Yapo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396385340 PECOS PAC ID: 1658707724 Enrollment ID: I20200208000139 |
| Provider Name | Andrew L Molnar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417439761 PECOS PAC ID: 8123458536 Enrollment ID: I20200428000025 |
| Provider Name | Jade N Balasz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780122036 PECOS PAC ID: 4486924487 Enrollment ID: I20200715003008 |
| Provider Name | Timothy Dekker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538516646 PECOS PAC ID: 1557655982 Enrollment ID: I20200917003178 |
| Provider Name | Kathryn Elyse Cox |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629561907 PECOS PAC ID: 9537415401 Enrollment ID: I20210824002154 |
| Provider Name | Zachary W Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437719507 PECOS PAC ID: 5799011458 Enrollment ID: I20220720000614 |
| Provider Name | Rasha S Bahri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598495574 PECOS PAC ID: 8022211424 Enrollment ID: I20230801001198 |
| Provider Name | Elvedina Ribic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033990205 PECOS PAC ID: 4082065461 Enrollment ID: I20240110002134 |
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