| Brentwood Meadows Physician Group Llc | |
|
4488 Roslin Rd Newburgh IN 47630-8590 | |
| (812) 858-7200 | |
| (812) 842-0086 |
| Full Name | Brentwood Meadows Physician Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4488 Roslin Rd, Newburgh, Indiana |
| Authorized Official Name and Position | Glenn D Bell (CEO) |
| Authorized Official Contact | 8128587200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brentwood Meadows Physician Group Llc 4488 Roslin Rd Newburgh IN 47630-8590 Ph: (812) 858-7200 | Brentwood Meadows Physician Group Llc 4488 Roslin Rd Newburgh IN 47630-8590 Ph: (812) 858-7200 |
| NPI Number | 1528479029 |
|---|---|
| Provider Enumeration Date | 05/19/2014 |
| Last Update Date | 10/23/2014 |
| Medicare PECOS PAC ID | 9830412956 |
|---|---|
| Medicare Enrollment ID | O20141222001827 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528479029 | NPI | - | NPPES |
| Provider Name | Samir Gamal Ishak |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548257488 PECOS PAC ID: 4880655331 Enrollment ID: I20041019001023 |
| Provider Name | Jennifer M Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528008893 PECOS PAC ID: 0244268043 Enrollment ID: I20050802001082 |
| Provider Name | Jessica Estes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487632709 PECOS PAC ID: 7113959867 Enrollment ID: I20051122000546 |
| Provider Name | Nikki J Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831277573 PECOS PAC ID: 5092814343 Enrollment ID: I20070627000209 |
| Provider Name | Patricia B Morrison |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780610303 PECOS PAC ID: 8123112943 Enrollment ID: I20070924000376 |
| Provider Name | Henry B Kaplan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003983719 PECOS PAC ID: 2365526704 Enrollment ID: I20080225000494 |
| Provider Name | Sarah E Parsons |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124041686 PECOS PAC ID: 9739286923 Enrollment ID: I20091124000363 |
| Provider Name | Sherri Mathies |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497060644 PECOS PAC ID: 1355538067 Enrollment ID: I20101207001086 |
| Provider Name | Robert D Patterson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417092107 PECOS PAC ID: 0244369890 Enrollment ID: I20111116000332 |
| Provider Name | Diahann Meekins Moore |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669707956 PECOS PAC ID: 3678611860 Enrollment ID: I20120619000445 |
| Provider Name | M Jeanette Kinman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528242187 PECOS PAC ID: 6103048343 Enrollment ID: I20141104000623 |
| Provider Name | Julie K Russell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144535030 PECOS PAC ID: 3173745403 Enrollment ID: I20141120001862 |
| Provider Name | Regina E Robison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316269871 PECOS PAC ID: 4880726231 Enrollment ID: I20141202000337 |
| Provider Name | Anna Philipose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740696467 PECOS PAC ID: 2961724844 Enrollment ID: I20141203002021 |
| Provider Name | Duke Fisher |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821044876 PECOS PAC ID: 1850618513 Enrollment ID: I20150318001278 |
| Provider Name | Rachel Sinclair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811183544 PECOS PAC ID: 8022167824 Enrollment ID: I20150608002366 |
| Provider Name | Tejas Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780097386 PECOS PAC ID: 2769773472 Enrollment ID: I20160627001666 |
| Provider Name | Olivia D Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255888475 PECOS PAC ID: 5395033849 Enrollment ID: I20161017000400 |
| Provider Name | Elizabeth A Taylor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770526618 PECOS PAC ID: 6103940333 Enrollment ID: I20161101002432 |
| Provider Name | Krista Thornberry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710347059 PECOS PAC ID: 1052602158 Enrollment ID: I20170602002111 |
| Provider Name | Xixi Wong |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174815997 PECOS PAC ID: 0648560607 Enrollment ID: I20170912001321 |
| Provider Name | Cuneyt Tegin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265850234 PECOS PAC ID: 1456626530 Enrollment ID: I20170929002521 |
| Provider Name | Michael O Arisa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235360058 PECOS PAC ID: 8325280605 Enrollment ID: I20180212000019 |
| Provider Name | Kenneth Richmond |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184891277 PECOS PAC ID: 6608015342 Enrollment ID: I20180517001225 |
| Provider Name | Vishal Viswam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245670611 PECOS PAC ID: 8123320595 Enrollment ID: I20181207002201 |
| Provider Name | Brent A. Crane |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336469287 PECOS PAC ID: 9739336058 Enrollment ID: I20181217000442 |
| Provider Name | Jacqueline Jones Toal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215488697 PECOS PAC ID: 8628358843 Enrollment ID: I20190405001521 |
| Provider Name | Joanna Wade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023482627 PECOS PAC ID: 3173826013 Enrollment ID: I20190604001957 |
| Provider Name | Lusine Vardanyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700430006 PECOS PAC ID: 2961732847 Enrollment ID: I20190918002909 |
| Provider Name | Melissa Anne Maxwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518502319 PECOS PAC ID: 7517394083 Enrollment ID: I20200221001208 |
| Provider Name | Sandra Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174148340 PECOS PAC ID: 7012337942 Enrollment ID: I20210308000854 |
| Provider Name | Elaine Lerner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518506898 PECOS PAC ID: 7214343276 Enrollment ID: I20210317001077 |
| Provider Name | Lee T Weng |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902849102 PECOS PAC ID: 9739358094 Enrollment ID: I20210419002027 |
| Provider Name | Megan Kay Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184202590 PECOS PAC ID: 6608271051 Enrollment ID: I20210823002153 |
| Provider Name | Paul Capell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083288617 PECOS PAC ID: 4385049675 Enrollment ID: I20210825001134 |
| Provider Name | Justin Lee Grose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225632110 PECOS PAC ID: 9739578105 Enrollment ID: I20211105002255 |
| Provider Name | Hannah Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144972944 PECOS PAC ID: 0840685194 Enrollment ID: I20220323001256 |
| Provider Name | Nicole Lynn Bradley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700519584 PECOS PAC ID: 5294118675 Enrollment ID: I20220817002818 |
| Provider Name | Phillip Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427404193 PECOS PAC ID: 7416243126 Enrollment ID: I20221024001231 |
| Provider Name | Lacy Pippin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609659119 PECOS PAC ID: 8729433479 Enrollment ID: I20231016002006 |
| Provider Name | Margaret Ellen Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851176408 PECOS PAC ID: 2264888965 Enrollment ID: I20231101002836 |
| Provider Name | Jordyn Leanne Brackett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548037534 PECOS PAC ID: 0345691713 Enrollment ID: I20240110001754 |
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