| Genesis Health System | |
|
1227 E Rusholme St Davenport IA 52803-2459 | |
| (563) 421-3408 | |
| (563) 421-3419 |
| Full Name | Genesis Health System |
|---|---|
| Speciality | Surgery |
| Location | 1227 E Rusholme St, Davenport, Iowa |
| Authorized Official Name and Position | Mark G Rogers (VP OF FINANCE / CFO) |
| Authorized Official Contact | 5634216513 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Health System Po Box 310083 Des Moines IA 50331-0083 Ph: (563) 421-3408 | Genesis Health System 1227 E Rusholme St Davenport IA 52803-2459 Ph: (563) 421-3408 |
| NPI Number | 1528616901 |
|---|---|
| Provider Enumeration Date | 08/29/2019 |
| Last Update Date | 09/11/2019 |
| Medicare PECOS PAC ID | 6103829338 |
|---|---|
| Medicare Enrollment ID | O20191031002622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528616901 | NPI | - | NPPES |
| Provider Name | Andrea B Jolley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154301463 PECOS PAC ID: 2668377656 Enrollment ID: I20031203000418 |
| Provider Name | David J Aanestad |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1548230832 PECOS PAC ID: 0042104580 Enrollment ID: I20040213000429 |
| Provider Name | Calvin E Atwell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1972574028 PECOS PAC ID: 7214824143 Enrollment ID: I20040303001224 |
| Provider Name | Akshay K Mahadevia |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1104891704 PECOS PAC ID: 0749179703 Enrollment ID: I20040518000688 |
| Provider Name | Stephen P Deporter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639174519 PECOS PAC ID: 8224019096 Enrollment ID: I20040527000252 |
| Provider Name | Matthew C Christophersen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1629048939 PECOS PAC ID: 7719960244 Enrollment ID: I20040608000102 |
| Provider Name | Christopher Michael Posey |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982666301 PECOS PAC ID: 1658346317 Enrollment ID: I20040827000174 |
| Provider Name | James H Hahn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902801525 PECOS PAC ID: 6608841085 Enrollment ID: I20040830000410 |
| Provider Name | Mohammed Irshad |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1508854589 PECOS PAC ID: 1759374788 Enrollment ID: I20040909001004 |
| Provider Name | Rebecca A Wiese |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1609921931 PECOS PAC ID: 4486613007 Enrollment ID: I20041007000689 |
| Provider Name | Rameshkumar K Raman |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1376521484 PECOS PAC ID: 2466412846 Enrollment ID: I20041012000526 |
| Provider Name | Benjamin A Vanraalte |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1528048451 PECOS PAC ID: 2264337567 Enrollment ID: I20041130000888 |
| Provider Name | Sarojini Kamaraju Ratnakar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679524672 PECOS PAC ID: 2466410279 Enrollment ID: I20041227000733 |
| Provider Name | Afzal H Abdullah |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1932199395 PECOS PAC ID: 2567402605 Enrollment ID: I20050507000081 |
| Provider Name | Bharat A Motwani |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1902885445 PECOS PAC ID: 1355375742 Enrollment ID: I20050926000016 |
| Provider Name | Franlynn Bugg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730142589 PECOS PAC ID: 3274550694 Enrollment ID: I20051025000926 |
| Provider Name | Stephen M Sorensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881647071 PECOS PAC ID: 1759273204 Enrollment ID: I20051107000248 |
| Provider Name | David M Spector |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1891754404 PECOS PAC ID: 0446215958 Enrollment ID: I20060307000382 |
| Provider Name | Rodney A Short |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1184602013 PECOS PAC ID: 5890705164 Enrollment ID: I20060501000744 |
| Provider Name | Kenneth J Hartman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1366407322 PECOS PAC ID: 5799798914 Enrollment ID: I20060711000003 |
| Provider Name | Robert E Harson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1356390207 PECOS PAC ID: 6901809110 Enrollment ID: I20061102000154 |
| Provider Name | Brian M Gross |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1740255348 PECOS PAC ID: 7618949579 Enrollment ID: I20070226000798 |
| Provider Name | Humphrey Wong |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1013982610 PECOS PAC ID: 5890767750 Enrollment ID: I20070226000808 |
| Provider Name | Paula Bryant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538353784 PECOS PAC ID: 6507951639 Enrollment ID: I20071003000689 |
| Provider Name | Young B Huh |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1407830912 PECOS PAC ID: 5294701629 Enrollment ID: I20071115000048 |
| Provider Name | Laurence M Deshields |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1861411084 PECOS PAC ID: 6608944020 Enrollment ID: I20081010000755 |
| Provider Name | Gaurav Ahuja |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1518144195 PECOS PAC ID: 8921169467 Enrollment ID: I20081203000146 |
| Provider Name | Teri A Devine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629213509 PECOS PAC ID: 5496802266 Enrollment ID: I20090414000161 |
| Provider Name | Srikrishna Chundru |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1932162815 PECOS PAC ID: 8527064120 Enrollment ID: I20090414000318 |
| Provider Name | Daniel E Wesemann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366435125 PECOS PAC ID: 5193707172 Enrollment ID: I20090512000425 |
| Provider Name | Richard T Nelson |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1255541843 PECOS PAC ID: 1355492398 Enrollment ID: I20090702000087 |
| Provider Name | Todd R Ridenour |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1306837075 PECOS PAC ID: 4688720022 Enrollment ID: I20090925000473 |
| Provider Name | Vinay V Satti |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629099726 PECOS PAC ID: 6204831860 Enrollment ID: I20091102000263 |
| Provider Name | Todd W Gray |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1447346630 PECOS PAC ID: 3971604422 Enrollment ID: I20091118000144 |
| Provider Name | Oliver M Ancheta |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1366400327 PECOS PAC ID: 1456441690 Enrollment ID: I20091207000017 |
| Provider Name | Anoop Aggarwal |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1902864739 PECOS PAC ID: 7113816992 Enrollment ID: I20091208000378 |
| Provider Name | Irena M Charysz Birski |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1821076753 PECOS PAC ID: 3274592837 Enrollment ID: I20100111000493 |
| Provider Name | Jeffrey M Wright |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770586463 PECOS PAC ID: 6800924119 Enrollment ID: I20100506000925 |
| Provider Name | Lisa A Davis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164483731 PECOS PAC ID: 9133258593 Enrollment ID: I20100522000044 |
| Provider Name | Ann F Kandis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275566317 PECOS PAC ID: 6800926254 Enrollment ID: I20100610000592 |
| Provider Name | Heather L Hunemuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649419219 PECOS PAC ID: 2264584663 Enrollment ID: I20100714000165 |
| Provider Name | Ann E Odonnell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376522243 PECOS PAC ID: 0244281335 Enrollment ID: I20100717000184 |
| Provider Name | Richard L Weyman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1295717478 PECOS PAC ID: 0840266276 Enrollment ID: I20100812000132 |
| Provider Name | David W.r. Dierks |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457519191 PECOS PAC ID: 5092839670 Enrollment ID: I20100903000087 |
| Provider Name | Jose E Torres |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1437368404 PECOS PAC ID: 7113043621 Enrollment ID: I20100921001508 |
| Provider Name | Mohsin A Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073712683 PECOS PAC ID: 2668515214 Enrollment ID: I20101005000475 |
| Provider Name | Joseph E Brooks |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1396904462 PECOS PAC ID: 9638232317 Enrollment ID: I20110720000563 |
| Provider Name | Kathryn K Dierks |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013143999 PECOS PAC ID: 5698943116 Enrollment ID: I20110727000310 |
| Provider Name | Nathan Michael Fierce |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1639355134 PECOS PAC ID: 2961534912 Enrollment ID: I20110728000355 |
| Provider Name | Jose A Armendariz |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1740509280 PECOS PAC ID: 5496924763 Enrollment ID: I20110803000656 |
| Provider Name | France B Many |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154643260 PECOS PAC ID: 5294907929 Enrollment ID: I20110930000397 |
| Provider Name | Randolph Bruce Lipscher |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699708271 PECOS PAC ID: 9133189012 Enrollment ID: I20120221001088 |
| Provider Name | Ramarao A Pradeep |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1548541154 PECOS PAC ID: 3173797560 Enrollment ID: I20120514000732 |
| Provider Name | Emily C Maiers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649527045 PECOS PAC ID: 5597914671 Enrollment ID: I20121004000682 |
| Provider Name | Cynthia C Lira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528311495 PECOS PAC ID: 7517110802 Enrollment ID: I20130118000011 |
| Provider Name | Stacey M Marlow Fisher |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1447559893 PECOS PAC ID: 3779737267 Enrollment ID: I20130211000044 |
| Provider Name | Suren Ravuri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104063536 PECOS PAC ID: 2860647682 Enrollment ID: I20130228000382 |
| Provider Name | Anand Kommuri |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1770819591 PECOS PAC ID: 4688813942 Enrollment ID: I20130617000536 |
| Provider Name | Michael A Burchett |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1669672325 PECOS PAC ID: 2567611569 Enrollment ID: I20130807000305 |
| Provider Name | Alaidden Taher |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1982918009 PECOS PAC ID: 8224271788 Enrollment ID: I20130830000697 |
| Provider Name | Katherine S Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689014961 PECOS PAC ID: 8527292598 Enrollment ID: I20131004000367 |
| Provider Name | Nathan C Meloy |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1598762841 PECOS PAC ID: 0345298683 Enrollment ID: I20131015001608 |
| Provider Name | Sarah B Schlickman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992138747 PECOS PAC ID: 6507092988 Enrollment ID: I20131112001997 |
| Provider Name | Leslie A Poston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154763845 PECOS PAC ID: 1456588292 Enrollment ID: I20131226000362 |
| Provider Name | Sasidhar Somuri |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1285954206 PECOS PAC ID: 4981898400 Enrollment ID: I20140220000742 |
| Provider Name | Heidi Bradley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972913978 PECOS PAC ID: 3072746338 Enrollment ID: I20140513000177 |
| Provider Name | Alicia L Duyvejonck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366858334 PECOS PAC ID: 4981823341 Enrollment ID: I20140917000206 |
| Provider Name | Orietta Girard |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396000337 PECOS PAC ID: 0143456277 Enrollment ID: I20141008001399 |
| Provider Name | Cassie A Welt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265759922 PECOS PAC ID: 2365684818 Enrollment ID: I20141015002117 |
| Provider Name | Jamsheed H Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578850277 PECOS PAC ID: 6002133261 Enrollment ID: I20150326001998 |
| Provider Name | Jacqueline Kitchen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700144813 PECOS PAC ID: 4587805924 Enrollment ID: I20150421000365 |
| Provider Name | Maryanne Ejidike |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1992124143 PECOS PAC ID: 4082925268 Enrollment ID: I20150615000410 |
| Provider Name | Destinee T Delemos |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356635858 PECOS PAC ID: 9436301868 Enrollment ID: I20150702002389 |
| Provider Name | Aina N Adekunle |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831445147 PECOS PAC ID: 2567775109 Enrollment ID: I20150727002685 |
| Provider Name | Andrew F Philip |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1093912818 PECOS PAC ID: 5991945081 Enrollment ID: I20150828000816 |
| Provider Name | Saysha M Bolden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497131304 PECOS PAC ID: 3577870211 Enrollment ID: I20150914001524 |
| Provider Name | Morgan Ryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104298314 PECOS PAC ID: 2365747201 Enrollment ID: I20160301002078 |
| Provider Name | Tyler John Whitcomb |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1770921694 PECOS PAC ID: 2466695770 Enrollment ID: I20160329002550 |
| Provider Name | Maureen T Cadmus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104811678 PECOS PAC ID: 5698721785 Enrollment ID: I20160428001859 |
| Provider Name | Kerry B Bramlett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023462108 PECOS PAC ID: 9335438357 Enrollment ID: I20160516000432 |
| Provider Name | Vidya Kollu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710346671 PECOS PAC ID: 5395036503 Enrollment ID: I20160620000196 |
| Provider Name | Oliver Dimitrijevic |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1003055252 PECOS PAC ID: 0547418766 Enrollment ID: I20160727000223 |
| Provider Name | Babuji Gandra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215184726 PECOS PAC ID: 6800042219 Enrollment ID: I20160728000024 |
| Provider Name | Brittney N Hughes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215383070 PECOS PAC ID: 8527352582 Enrollment ID: I20160815000522 |
| Provider Name | Mintesinot T Fitamo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1255760260 PECOS PAC ID: 9537455282 Enrollment ID: I20160907001679 |
| Provider Name | Sunil K Avvari |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1437441672 PECOS PAC ID: 2062682818 Enrollment ID: I20160927000328 |
| Provider Name | Valerie R. Wold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265980668 PECOS PAC ID: 8729375043 Enrollment ID: I20160929001025 |
| Provider Name | Catherine Karno |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1144516345 PECOS PAC ID: 0143535245 Enrollment ID: I20160930000125 |
| Provider Name | Heather M Hitesman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992259642 PECOS PAC ID: 0446547673 Enrollment ID: I20161003000068 |
| Provider Name | Molly A Stehn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508218629 PECOS PAC ID: 2668760810 Enrollment ID: I20161004001775 |
| Provider Name | Mudappa K Kalaiah |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1942457981 PECOS PAC ID: 5395967798 Enrollment ID: I20161011000203 |
| Provider Name | Maureen M Gulatto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831645308 PECOS PAC ID: 4082902796 Enrollment ID: I20161013000088 |
| Provider Name | Oyakhire C Ofori |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1063962710 PECOS PAC ID: 1355639865 Enrollment ID: I20161017002469 |
| Provider Name | Kristine M Morland-schultz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922383280 PECOS PAC ID: 8325272768 Enrollment ID: I20161130002705 |
| Provider Name | Ryan J Taylor |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1417299330 PECOS PAC ID: 0244462752 Enrollment ID: I20170614001486 |
| Provider Name | Darceen J Mccutcheon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851308647 PECOS PAC ID: 5395647481 Enrollment ID: I20170614001507 |
| Provider Name | Cassaundra Mutum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518497874 PECOS PAC ID: 0840560074 Enrollment ID: I20170721000114 |
| Provider Name | Janet L Annen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386028165 PECOS PAC ID: 8628383080 Enrollment ID: I20170804002528 |
| Provider Name | Morgan C Barnell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821401506 PECOS PAC ID: 6800190109 Enrollment ID: I20170808002900 |
| Provider Name | Samyuktha Ramavaram |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1467743039 PECOS PAC ID: 8022334564 Enrollment ID: I20170831001154 |
| Provider Name | Elisa Marie Smith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750798872 PECOS PAC ID: 3678792108 Enrollment ID: I20170918002633 |
| Provider Name | Leanne M Binion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255853347 PECOS PAC ID: 7618242785 Enrollment ID: I20170929001956 |
| Provider Name | Michael D Craddick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831503820 PECOS PAC ID: 6709107626 Enrollment ID: I20171018002791 |
| Provider Name | Mark A Pithan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1184680605 PECOS PAC ID: 4486713815 Enrollment ID: I20180119000144 |
| Provider Name | Aloka S Amarakone |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1407051329 PECOS PAC ID: 7315117827 Enrollment ID: I20180420001872 |
| Provider Name | Angela K Stork |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1386932192 PECOS PAC ID: 7618111030 Enrollment ID: I20180710002223 |
| Provider Name | Brian D Witt |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1952628646 PECOS PAC ID: 2466759675 Enrollment ID: I20180716000751 |
| Provider Name | Amy Burkhart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255820619 PECOS PAC ID: 3971851551 Enrollment ID: I20180731000302 |
| Provider Name | Kayla L Ehrman |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1316357494 PECOS PAC ID: 7214259936 Enrollment ID: I20180830002506 |
| Provider Name | Allan Hu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1992092167 PECOS PAC ID: 8921358029 Enrollment ID: I20180911003539 |
| Provider Name | Chantelle E Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336655828 PECOS PAC ID: 9830451152 Enrollment ID: I20181108001481 |
| Provider Name | Sumit Patel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1851786925 PECOS PAC ID: 0345596979 Enrollment ID: I20181119002706 |
| Provider Name | Megan I Mcneil |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639581739 PECOS PAC ID: 2062637259 Enrollment ID: I20181128002522 |
| Provider Name | Michael Porubcin |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1770553349 PECOS PAC ID: 3779488788 Enrollment ID: I20190104000819 |
| Provider Name | Stewart Charles Garneau |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1336132943 PECOS PAC ID: 1658367255 Enrollment ID: I20190115001891 |
| Provider Name | Brittany B Price |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710364492 PECOS PAC ID: 5991019671 Enrollment ID: I20190115003227 |
| Provider Name | Angus Y Ng |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053355198 PECOS PAC ID: 7416996582 Enrollment ID: I20190118002040 |
| Provider Name | Betheal G Aschenaki |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1992191050 PECOS PAC ID: 2163793621 Enrollment ID: I20190326001416 |
| Provider Name | Arpit Trivedi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1346636586 PECOS PAC ID: 8123399219 Enrollment ID: I20190328001993 |
| Provider Name | Edward M Powers |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1184019895 PECOS PAC ID: 6608146899 Enrollment ID: I20190402000673 |
| Provider Name | Brandy A Chisholm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952874315 PECOS PAC ID: 1052644226 Enrollment ID: I20190605002037 |
| Provider Name | Shipeng Wei |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1023469798 PECOS PAC ID: 4789970179 Enrollment ID: I20190709000693 |
| Provider Name | Seema Antony |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457914657 PECOS PAC ID: 8123353026 Enrollment ID: I20190715003147 |
| Provider Name | Emaad Basith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689025108 PECOS PAC ID: 7618269341 Enrollment ID: I20190723003068 |
| Provider Name | Nhuhang Ho |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1780039487 PECOS PAC ID: 2961780507 Enrollment ID: I20190726002879 |
| Provider Name | Malesse B Waje |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1790138451 PECOS PAC ID: 6800140682 Enrollment ID: I20190802001089 |
| Provider Name | Blake Bashor |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417339748 PECOS PAC ID: 5193009843 Enrollment ID: I20190820000587 |
| Provider Name | Alexander J Tucker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750732210 PECOS PAC ID: 1850684432 Enrollment ID: I20190821002615 |
| Provider Name | Devin W Toll |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497138028 PECOS PAC ID: 4688969777 Enrollment ID: I20190822000405 |
| Provider Name | Fikru G Heramo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1962864751 PECOS PAC ID: 1759619927 Enrollment ID: I20190826002829 |
| Provider Name | Andrea L Lingenfelter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073092383 PECOS PAC ID: 7517219884 Enrollment ID: I20190828001350 |
| Provider Name | Abdallah M Al Moussa |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1497107759 PECOS PAC ID: 1850685520 Enrollment ID: I20190904002550 |
| Provider Name | Tyrone Galbreath |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1356636245 PECOS PAC ID: 7416178199 Enrollment ID: I20190916000545 |
| Provider Name | Julie E Wheeler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477105047 PECOS PAC ID: 5294881728 Enrollment ID: I20191014003247 |
| Provider Name | Ahmad M Nafe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841640190 PECOS PAC ID: 9638401078 Enrollment ID: I20191104002513 |
| Provider Name | Alyssa S Hartweg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942850011 PECOS PAC ID: 3274965074 Enrollment ID: I20191116000278 |
| Provider Name | Michael Be |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730671470 PECOS PAC ID: 7719237643 Enrollment ID: I20200110002002 |
| Provider Name | Spencer J Kissel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013499029 PECOS PAC ID: 4880948140 Enrollment ID: I20200218001918 |
| Provider Name | Melyssa K Mosley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194232850 PECOS PAC ID: 6507128568 Enrollment ID: I20200330002051 |
| Provider Name | Brooke E Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326561150 PECOS PAC ID: 9133485972 Enrollment ID: I20200416001900 |
| Provider Name | Marie L Mueller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699309377 PECOS PAC ID: 3072944404 Enrollment ID: I20200519000296 |
| Provider Name | Anna Mark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497249098 PECOS PAC ID: 1355698796 Enrollment ID: I20200527002373 |
| Provider Name | Ifeoma N Achebe |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1578085700 PECOS PAC ID: 4284057480 Enrollment ID: I20200707000896 |
| Provider Name | Ashley Borden |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588198956 PECOS PAC ID: 5092085647 Enrollment ID: I20200707001090 |
| Provider Name | Samer A Abu Alula |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447782578 PECOS PAC ID: 5597188292 Enrollment ID: I20200714002429 |
| Provider Name | Abiy Abebe |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1154855104 PECOS PAC ID: 3274958384 Enrollment ID: I20200806002675 |
| Provider Name | Rajdip Barman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326393141 PECOS PAC ID: 0648413849 Enrollment ID: I20200810002961 |
| Provider Name | Abby M Shumate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912523432 PECOS PAC ID: 8820414030 Enrollment ID: I20200819000102 |
| Provider Name | Anne M Sinnott |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578651311 PECOS PAC ID: 4082624184 Enrollment ID: I20200826003382 |
| Provider Name | Farrukh Fayyaz |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1851811715 PECOS PAC ID: 0042638025 Enrollment ID: I20200909000330 |
| Provider Name | Lauren E Rumburg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912516881 PECOS PAC ID: 5799104337 Enrollment ID: I20200930002157 |
| Provider Name | Ashley R Caes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740895853 PECOS PAC ID: 9234558602 Enrollment ID: I20201005000785 |
| Provider Name | Yifeng Yang |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1760903249 PECOS PAC ID: 7315367588 Enrollment ID: I20201009001227 |
| Provider Name | Sowmya Veerapaneni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699149211 PECOS PAC ID: 8123326279 Enrollment ID: I20201014000348 |
| Provider Name | Nicole A Bindl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083801153 PECOS PAC ID: 5799904736 Enrollment ID: I20201026002633 |
| Provider Name | Hilton M Hudson |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1689614828 PECOS PAC ID: 7911984513 Enrollment ID: I20201027002891 |
| Provider Name | Edward J Coleman |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1801889845 PECOS PAC ID: 9638147259 Enrollment ID: I20201201002351 |
| Provider Name | Katie G Kasper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790155836 PECOS PAC ID: 8224339890 Enrollment ID: I20201217002030 |
| Provider Name | Timothy W Swain |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1295742898 PECOS PAC ID: 6608859095 Enrollment ID: I20210225002664 |
| Provider Name | Ruggero Serafini |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306084561 PECOS PAC ID: 6800084732 Enrollment ID: I20210406001653 |
| Provider Name | Marceline Kougbani-sebou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558996942 PECOS PAC ID: 6901211523 Enrollment ID: I20210413000553 |
| Provider Name | Mohammad A Kotob |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1538726617 PECOS PAC ID: 4284969395 Enrollment ID: I20210603000841 |
| Provider Name | Ryan B Perumpail |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1649546623 PECOS PAC ID: 0547578502 Enrollment ID: I20210628000507 |
| Provider Name | Syed Faisal Jafri |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1609929868 PECOS PAC ID: 7315998408 Enrollment ID: I20210701000590 |
| Provider Name | Morgan Leigh Nichols |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952890196 PECOS PAC ID: 7517395049 Enrollment ID: I20210820000970 |
| Provider Name | Jesicah E Ambrisco |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1023502622 PECOS PAC ID: 5698022176 Enrollment ID: I20210824000938 |
| Provider Name | Daniel S Kinker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942705975 PECOS PAC ID: 5698021574 Enrollment ID: I20210824001130 |
| Provider Name | Amanda J Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528503695 PECOS PAC ID: 9537441779 Enrollment ID: I20210930000164 |
| Provider Name | Lindsay M Chick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043821440 PECOS PAC ID: 2163833724 Enrollment ID: I20211005002084 |
| Provider Name | Jaspreet Singh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073176392 PECOS PAC ID: 0446592984 Enrollment ID: I20211021000887 |
| Provider Name | Floyd D Howell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124253240 PECOS PAC ID: 7315196771 Enrollment ID: I20211109002831 |
| Provider Name | Matthew P Lazio |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790978260 PECOS PAC ID: 6608913942 Enrollment ID: I20211130001041 |
| Provider Name | Avigdor G Asner |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1962061242 PECOS PAC ID: 8123357985 Enrollment ID: I20211207000766 |
| Provider Name | Philip L Strauss |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952347296 PECOS PAC ID: 4981730504 Enrollment ID: I20211207001709 |
| Provider Name | Hannah E Peck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134885528 PECOS PAC ID: 4880085166 Enrollment ID: I20211221000752 |
| Provider Name | Alison E Fraehlich |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1205495736 PECOS PAC ID: 4789912643 Enrollment ID: I20211221000837 |
| Provider Name | Swarna L Masala |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1649839465 PECOS PAC ID: 0143559906 Enrollment ID: I20211221001108 |
| Provider Name | Shona R Ernst |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689348633 PECOS PAC ID: 8527452366 Enrollment ID: I20220222000641 |
| Provider Name | Bo Leung |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1932635539 PECOS PAC ID: 4688087513 Enrollment ID: I20220228001946 |
| Provider Name | Adiba M Sirojeva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700559911 PECOS PAC ID: 0446644686 Enrollment ID: I20220303001457 |
| Provider Name | Mary A Defrance |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184244584 PECOS PAC ID: 2769806793 Enrollment ID: I20220307001063 |
| Provider Name | Audrey M Bunce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902567639 PECOS PAC ID: 7810382645 Enrollment ID: I20220315000437 |
| Provider Name | Rebecca A Solomon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770133159 PECOS PAC ID: 0547683740 Enrollment ID: I20220405000664 |
| Provider Name | Alvin J Murn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225081268 PECOS PAC ID: 0648228601 Enrollment ID: I20220413000437 |
| Provider Name | Jayashree T Gowda |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1811334485 PECOS PAC ID: 1951532365 Enrollment ID: I20220420001603 |
| Provider Name | Sara A Daily |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871245878 PECOS PAC ID: 1355738402 Enrollment ID: I20220420001802 |
| Provider Name | Nicole Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558731075 PECOS PAC ID: 7719289370 Enrollment ID: I20220505002004 |
| Provider Name | Fellipe Lima Nobre De Queiroz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417511205 PECOS PAC ID: 7719212935 Enrollment ID: I20220601000259 |
| Provider Name | Thayer S Phelan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821209354 PECOS PAC ID: 6305029646 Enrollment ID: I20220613002513 |
| Provider Name | Ethan Monhollon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962965681 PECOS PAC ID: 1658613336 Enrollment ID: I20220623002121 |
| Provider Name | Abraham Maaz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033679287 PECOS PAC ID: 0648659227 Enrollment ID: I20220628002858 |
| Provider Name | Robert P Boyle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346557550 PECOS PAC ID: 4789086513 Enrollment ID: I20220701000729 |
| Provider Name | Melissa M Caldwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134883622 PECOS PAC ID: 9537549720 Enrollment ID: I20220706001116 |
| Provider Name | Brian E Payden |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063078418 PECOS PAC ID: 1052704699 Enrollment ID: I20220806000573 |
| Provider Name | Ebrahim Alqadasi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1821559725 PECOS PAC ID: 3274916283 Enrollment ID: I20220823003087 |
| Provider Name | Faraz A Khan |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1427582543 PECOS PAC ID: 1052681731 Enrollment ID: I20220830001909 |
| Provider Name | Kimberly Hurley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851024004 PECOS PAC ID: 8022492412 Enrollment ID: I20220902001727 |
| Provider Name | Deborah Widmer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346555166 PECOS PAC ID: 1850589482 Enrollment ID: I20220908002101 |
| Provider Name | Richard P Cutts |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1952835266 PECOS PAC ID: 1355611047 Enrollment ID: I20220912000589 |
| Provider Name | Andy Liu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285082446 PECOS PAC ID: 4789916784 Enrollment ID: I20221005003025 |
| Provider Name | Ashley Shonese Barfield |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487001624 PECOS PAC ID: 8224365960 Enrollment ID: I20221018000623 |
| Provider Name | Ndieme Ndoye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215550066 PECOS PAC ID: 3971910019 Enrollment ID: I20221019000458 |
| Provider Name | Malik Adil |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174941488 PECOS PAC ID: 5890914956 Enrollment ID: I20221119000357 |
| Provider Name | Jaclyn A Brandmeyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881224376 PECOS PAC ID: 1254749732 Enrollment ID: I20221122002760 |
| Provider Name | Wael Azer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841588241 PECOS PAC ID: 5991017840 Enrollment ID: I20221219002622 |
| Provider Name | Huitzilin Mauricio Olmecah |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1821181553 PECOS PAC ID: 9638277239 Enrollment ID: I20221220001028 |
| Provider Name | Kimberly Brown |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154716306 PECOS PAC ID: 9133440811 Enrollment ID: I20221222001008 |
| Provider Name | Steven M Glerum |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902062888 PECOS PAC ID: 4183928930 Enrollment ID: I20221222001221 |
| Provider Name | Khoa Dang Nguyen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245674159 PECOS PAC ID: 3779784699 Enrollment ID: I20230123002570 |
| Provider Name | Michaela A Meyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578217857 PECOS PAC ID: 6507237468 Enrollment ID: I20230201001024 |
| Provider Name | Kalyan Sajja |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346682861 PECOS PAC ID: 1052542347 Enrollment ID: I20230210000124 |
| Provider Name | Geetha P Krishnan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699067132 PECOS PAC ID: 5092980938 Enrollment ID: I20230216000267 |
| Provider Name | Mark J Shen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346539467 PECOS PAC ID: 0244457935 Enrollment ID: I20230221000735 |
| Provider Name | Rania Hafeth Saleh |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1326280264 PECOS PAC ID: 8022265685 Enrollment ID: I20230223000206 |
| Provider Name | Tina M Noone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144604323 PECOS PAC ID: 4688989957 Enrollment ID: I20230307002872 |
| Provider Name | Nancy A Rihana |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1982835237 PECOS PAC ID: 5294954699 Enrollment ID: I20230331001452 |
| Provider Name | Eugene Kang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376968552 PECOS PAC ID: 2769601293 Enrollment ID: I20230410001954 |
| Provider Name | Patrick A Craddock |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477518710 PECOS PAC ID: 1658308218 Enrollment ID: I20230412002606 |
| Provider Name | Frank Mu |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952756694 PECOS PAC ID: 3779878889 Enrollment ID: I20230413001225 |
| Provider Name | Natalie A Reitz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285331058 PECOS PAC ID: 6901261452 Enrollment ID: I20230505000480 |
| Provider Name | Katherine A Fitzpatrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366142051 PECOS PAC ID: 5395101760 Enrollment ID: I20230510002288 |
| Provider Name | Ekezie M Francis |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1619255213 PECOS PAC ID: 9739302639 Enrollment ID: I20230516001493 |
| Provider Name | Ahmed Z Elmaadawi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114189305 PECOS PAC ID: 3678744240 Enrollment ID: I20230602001212 |
| Provider Name | Brian Nelson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801259205 PECOS PAC ID: 1254625007 Enrollment ID: I20230613001703 |
| Provider Name | Laura J Amidon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508967837 PECOS PAC ID: 3870517675 Enrollment ID: I20230615000488 |
| Provider Name | Heather Shuey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821703307 PECOS PAC ID: 4385002807 Enrollment ID: I20230615000920 |
| Provider Name | Margaret Lohf |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1881218501 PECOS PAC ID: 1557761434 Enrollment ID: I20230803001113 |
| Provider Name | Benjamin D Acton |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1013409903 PECOS PAC ID: 6002166717 Enrollment ID: I20230809003450 |
| Provider Name | Diana M Mahbod |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1689931974 PECOS PAC ID: 6901110089 Enrollment ID: I20230821002680 |
| Provider Name | Michella Azar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922480201 PECOS PAC ID: 9234441346 Enrollment ID: I20230821003377 |
| Provider Name | Salem Gaballa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619471810 PECOS PAC ID: 4183976954 Enrollment ID: I20230822000127 |
| Provider Name | Michael Langham Williams |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811375835 PECOS PAC ID: 5799066007 Enrollment ID: I20230823003588 |
| Provider Name | Kathryn Swain-abraham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497107296 PECOS PAC ID: 3971896200 Enrollment ID: I20230825003227 |
| Provider Name | Chelsea J Meyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548945439 PECOS PAC ID: 0244693992 Enrollment ID: I20230828002940 |
| Provider Name | Ammer Al-dairi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1477181352 PECOS PAC ID: 5395169320 Enrollment ID: I20230830003623 |
| Provider Name | Ravali Tarigopula |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1285802892 PECOS PAC ID: 0547427346 Enrollment ID: I20230906000509 |
| Provider Name | Michael Yang |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1417338229 PECOS PAC ID: 4082905369 Enrollment ID: I20230911001091 |
| Provider Name | Allyson Winter |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1598260911 PECOS PAC ID: 0042567190 Enrollment ID: I20230911001541 |
| Provider Name | Anna Starcevich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710659495 PECOS PAC ID: 6406241967 Enrollment ID: I20230914000801 |
| Provider Name | Raina Shanks |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417008475 PECOS PAC ID: 0941364418 Enrollment ID: I20230914000986 |
| Provider Name | Mayra Lizbeth Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881373363 PECOS PAC ID: 9931553948 Enrollment ID: I20230925003318 |
| Provider Name | Melissa Burkle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710665278 PECOS PAC ID: 4880048735 Enrollment ID: I20230926001742 |
| Provider Name | Thomas Kleisli |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1518195627 PECOS PAC ID: 1850686056 Enrollment ID: I20231017003519 |
| Provider Name | Brittany P Schultz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982387635 PECOS PAC ID: 3274988704 Enrollment ID: I20231018001503 |
| Provider Name | Hanyang Liu |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1891569208 PECOS PAC ID: 8426406620 Enrollment ID: I20231129000786 |
| Provider Name | Ashley Fratello |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1619390465 PECOS PAC ID: 2264760131 Enrollment ID: I20231214001164 |
| Provider Name | Ahamed Khalyfa |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1336777879 PECOS PAC ID: 0244654416 Enrollment ID: I20231214001977 |
| Provider Name | Amanda Noel Lauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114704004 PECOS PAC ID: 5092164095 Enrollment ID: I20231216000138 |
| Provider Name | Richard William Payden |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1306223110 PECOS PAC ID: 2062728595 Enrollment ID: I20240102003124 |
| Provider Name | Kati Wijdenes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295181071 PECOS PAC ID: 4486006251 Enrollment ID: I20240117001835 |
| Provider Name | David Chiapaikeo |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1174814644 PECOS PAC ID: 3870858723 Enrollment ID: I20240206002375 |
| Provider Name | Sandi Hartje |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1215323571 PECOS PAC ID: 3971932575 Enrollment ID: I20240208001369 |
| Provider Name | Mahmoud Mohamed Elfadil |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1669907242 PECOS PAC ID: 3678841467 Enrollment ID: I20240227002578 |
| Provider Name | Mohamed Gashouta |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1427311877 PECOS PAC ID: 1456599190 Enrollment ID: I20240307000401 |
| Provider Name | Christopher Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295232684 PECOS PAC ID: 9931594934 Enrollment ID: I20240410002446 |
| Provider Name | Jessica Visser |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1912249756 PECOS PAC ID: 6901185784 Enrollment ID: I20240426002180 |
| Provider Name | Ghita Moussaide |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1649535667 PECOS PAC ID: 3274813266 Enrollment ID: I20240426002323 |
| Provider Name | Jeanea Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972227304 PECOS PAC ID: 9638545676 Enrollment ID: I20240503003535 |
| Provider Name | Haley F Bielenberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851154744 PECOS PAC ID: 3870934748 Enrollment ID: I20240509000260 |
Courageous Aim Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2805 Eastern Ave Ste D, Davenport, IA 52803 Phone: 563-505-0141 | |
Vera French Community Mental Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1441 W Central Park Ave, Davenport, IA 52804 Phone: 563-383-1900 Fax: 563-328-5690 | |
Hope For Tomorrow Therapy Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1140 E Kimberly Rd Ste 110, Davenport, IA 52807 Phone: 563-200-3154 Fax: 833-228-5356 | |
Ciaccio Medical, P.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1401 W Central Park Ave, Davenport, IA 52804 Phone: 309-236-8075 | |
The Robert Young Center For Community Mental Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 12160 S Utah Ave, Davenport, IA 52804 Phone: 563-326-1150 | |
Revolution Counseling Services Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 601 Brady St Ste 204, Davenport, IA 52803 Phone: 309-781-4053 Fax: 309-792-2440 | |
Bhg Medical Services - Iowa Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3811 North Harrison Street, Obot Room #100, Davenport, IA 52806 Phone: 563-388-8000 Fax: 563-388-8002 |