| Cedar Centre Psychiatric Group | |
|
1730 1st Ave Ne Cedar Rapids IA 52402-5433 | |
| (319) 365-3993 | |
| (319) 364-0116 |
| Full Name | Cedar Centre Psychiatric Group |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1730 1st Ave Ne, Cedar Rapids, Iowa |
| Authorized Official Name and Position | Bryan Netolicky (PARTNER) |
| Authorized Official Contact | 3193653993 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedar Centre Psychiatric Group Po Box 1408 Cedar Rapids IA 52406-1408 Ph: (319) 365-3993 | Cedar Centre Psychiatric Group 1730 1st Ave Ne Cedar Rapids IA 52402-5433 Ph: (319) 365-3993 |
| NPI Number | 1558338012 |
|---|---|
| Provider Enumeration Date | 03/03/2006 |
| Last Update Date | 02/25/2016 |
| Medicare PECOS PAC ID | 6204726342 |
|---|---|
| Medicare Enrollment ID | O20040319001123 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558338012 | NPI | - | NPPES |
| 0174151 | Medicaid | IA | |
| 17415 | Other | IA | WELLMARK BC/BS |
| Provider Name | Christine R Cork |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306060108 PECOS PAC ID: 0840264263 Enrollment ID: I20040823000463 |
| Provider Name | Paul J Sundell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316914898 PECOS PAC ID: 3375570187 Enrollment ID: I20050725000072 |
| Provider Name | Bryan David Netolicky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255405338 PECOS PAC ID: 8325072044 Enrollment ID: I20050922000352 |
| Provider Name | Allyson L Wheaton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063491645 PECOS PAC ID: 2961476197 Enrollment ID: I20051020000530 |
| Provider Name | Gregory Hotsenpiller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275655458 PECOS PAC ID: 3476646886 Enrollment ID: I20070830000368 |
| Provider Name | Ann E Blake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093842551 PECOS PAC ID: 6204929409 Enrollment ID: I20070904000559 |
| Provider Name | Rebecca Wolfe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215146055 PECOS PAC ID: 6800923012 Enrollment ID: I20100420000735 |
| Provider Name | Thomas W Hansen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689653149 PECOS PAC ID: 6406820638 Enrollment ID: I20100513000696 |
| Provider Name | Joan Tatarka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275548083 PECOS PAC ID: 1355472820 Enrollment ID: I20100628000059 |
| Provider Name | Kija M Weldon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831419316 PECOS PAC ID: 7113167206 Enrollment ID: I20140108001949 |
| Provider Name | Jeniece M Nott |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093941460 PECOS PAC ID: 1557501053 Enrollment ID: I20150624000413 |
| Provider Name | Nicole Lynne Strong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760861892 PECOS PAC ID: 4688930266 Enrollment ID: I20171115000444 |
| Provider Name | Dorthea Wheeler |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043878705 PECOS PAC ID: 5698000792 Enrollment ID: I20231107000526 |
| Provider Name | Jonathan Thomas Heinzman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881154565 PECOS PAC ID: 3779818885 Enrollment ID: I20240719002085 |
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