| Providence Medical Group Southeast Washington | |
|
380 Chase Avenue Pmg Se Wa Walla Walla WA 99362-2924 | |
| (509) 526-3333 | |
| (509) 526-8402 |
| Full Name | Providence Medical Group Southeast Washington |
|---|---|
| Speciality | Family Medicine |
| Location | 380 Chase Avenue, Walla Walla, Washington |
| Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC OF ENROLLMENT/DIR REIMB ST) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Southeast Washington Po Box 32 Liberty Lake WA 99019-0032 Ph: (509) 529-8905 | Providence Medical Group Southeast Washington 380 Chase Avenue Pmg Se Wa Walla Walla WA 99362-2924 Ph: (509) 526-3333 |
| NPI Number | 1922259738 |
|---|---|
| Provider Enumeration Date | 10/10/2008 |
| Last Update Date | 09/02/2022 |
| Certification Date | 09/02/2022 |
| Medicare PECOS PAC ID | 2860552973 |
|---|---|
| Medicare Enrollment ID | O20081223000478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922259738 | NPI | - | NPPES |
| 115284 | Other | WA | L&I STATE |
| 7028186 | Medicaid | WA |
| Provider Name | Onder Orgul |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1932123601 PECOS PAC ID: 2163320904 Enrollment ID: I20031230000630 |
| Provider Name | Philip A Green |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104867373 PECOS PAC ID: 7315831450 Enrollment ID: I20040210001025 |
| Provider Name | Hui-juan Zhang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1689625014 PECOS PAC ID: 3870482821 Enrollment ID: I20040329000563 |
| Provider Name | Michael Ring |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1467455543 PECOS PAC ID: 1153310693 Enrollment ID: I20040510000719 |
| Provider Name | Cameron J Seibold |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932161775 PECOS PAC ID: 7113916552 Enrollment ID: I20040510001548 |
| Provider Name | David A Thorne |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1124081138 PECOS PAC ID: 2769473305 Enrollment ID: I20040521000370 |
| Provider Name | Aaron B Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265446678 PECOS PAC ID: 7012993371 Enrollment ID: I20040628000214 |
| Provider Name | Andrew T Coletti |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1255381109 PECOS PAC ID: 5294705836 Enrollment ID: I20040802000987 |
| Provider Name | Lauri R Larson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477567881 PECOS PAC ID: 0042281263 Enrollment ID: I20040803000166 |
| Provider Name | Damanjeet S Chugh |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1366492944 PECOS PAC ID: 8224092473 Enrollment ID: I20041117000261 |
| Provider Name | Brandon N Ong |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1013968072 PECOS PAC ID: 2466405535 Enrollment ID: I20050301000473 |
| Provider Name | James R Cunningham |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1568476752 PECOS PAC ID: 0446286983 Enrollment ID: I20050715000158 |
| Provider Name | Robert A Billingsley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487668893 PECOS PAC ID: 2466480371 Enrollment ID: I20050802000289 |
| Provider Name | Jayson S Brower |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346298361 PECOS PAC ID: 0749179414 Enrollment ID: I20051012001002 |
| Provider Name | Adam D Ostrowski |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1053399287 PECOS PAC ID: 4183640105 Enrollment ID: I20051019000762 |
| Provider Name | Carmen L Ehlers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437135050 PECOS PAC ID: 6709803299 Enrollment ID: I20051024000888 |
| Provider Name | Patricia A Waring |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275557928 PECOS PAC ID: 0143212852 Enrollment ID: I20051026000942 |
| Provider Name | Jennifer Lee Christenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457336158 PECOS PAC ID: 3476572330 Enrollment ID: I20051121000415 |
| Provider Name | Ednea A Simon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174604425 PECOS PAC ID: 9335160340 Enrollment ID: I20051216000671 |
| Provider Name | Paul L Mclain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497861884 PECOS PAC ID: 9032125968 Enrollment ID: I20060301000323 |
| Provider Name | Siting S S Chen |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1689662587 PECOS PAC ID: 4183634504 Enrollment ID: I20060501000326 |
| Provider Name | Sara E Hellberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174576094 PECOS PAC ID: 5496766628 Enrollment ID: I20060531000241 |
| Provider Name | Jose Gude |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063432292 PECOS PAC ID: 5092719336 Enrollment ID: I20060829000408 |
| Provider Name | Karen L Geheb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972532745 PECOS PAC ID: 9537154323 Enrollment ID: I20060918000358 |
| Provider Name | Bradford J Brouillette |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1861589350 PECOS PAC ID: 0042218828 Enrollment ID: I20061110000404 |
| Provider Name | Richard L Henderson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1437129947 PECOS PAC ID: 4183622483 Enrollment ID: I20061121000351 |
| Provider Name | Fermin S Godinez |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639149966 PECOS PAC ID: 9931107844 Enrollment ID: I20061130000483 |
| Provider Name | Miriam A Jaffee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730285412 PECOS PAC ID: 7517967243 Enrollment ID: I20070108000346 |
| Provider Name | Timothy A Davidson |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1124032511 PECOS PAC ID: 8628070463 Enrollment ID: I20070208000173 |
| Provider Name | Glyn E A Marsh |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1316031255 PECOS PAC ID: 1658373162 Enrollment ID: I20070213000624 |
| Provider Name | Christopher S Famy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043329840 PECOS PAC ID: 7113023672 Enrollment ID: I20070501000159 |
| Provider Name | Michael J Reznicek |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760568760 PECOS PAC ID: 0749389849 Enrollment ID: I20070629000304 |
| Provider Name | Donald E Wakelin |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1790820546 PECOS PAC ID: 5193825982 Enrollment ID: I20070709000475 |
| Provider Name | Bevan W Briggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841277340 PECOS PAC ID: 2567562259 Enrollment ID: I20070710000890 |
| Provider Name | Suwong Wongsuwan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1497700975 PECOS PAC ID: 5193816270 Enrollment ID: I20070803000028 |
| Provider Name | Brandon T Thomas |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750308359 PECOS PAC ID: 4082647417 Enrollment ID: I20070814000175 |
| Provider Name | Christopher T Romey |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245444132 PECOS PAC ID: 6709987118 Enrollment ID: I20070912000117 |
| Provider Name | Sheila D Smith |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487859708 PECOS PAC ID: 7911090519 Enrollment ID: I20070912000164 |
| Provider Name | Jon V Rittenbach |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1164569455 PECOS PAC ID: 1153416854 Enrollment ID: I20070926000583 |
| Provider Name | Bryan P Potter |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1316967045 PECOS PAC ID: 4981692431 Enrollment ID: I20071108000131 |
| Provider Name | Arpan Waghray |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801088794 PECOS PAC ID: 5597847459 Enrollment ID: I20080130000729 |
| Provider Name | Philip M Coff |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1477550572 PECOS PAC ID: 3476589383 Enrollment ID: I20080205000128 |
| Provider Name | David Timothy Maxwell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427261882 PECOS PAC ID: 4284719865 Enrollment ID: I20080722000300 |
| Provider Name | Christina Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982791521 PECOS PAC ID: 4385711704 Enrollment ID: I20080925000656 |
| Provider Name | Frederick J Gunningham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447302658 PECOS PAC ID: 2668540725 Enrollment ID: I20081003000036 |
| Provider Name | Monica Marton Popovici |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437326626 PECOS PAC ID: 4385705763 Enrollment ID: I20081203000653 |
| Provider Name | Dany E Ghannam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114114014 PECOS PAC ID: 7517020316 Enrollment ID: I20090105000488 |
| Provider Name | William M Breland |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1396759700 PECOS PAC ID: 5597828285 Enrollment ID: I20090106000774 |
| Provider Name | Rachel Lapier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922114313 PECOS PAC ID: 9234292970 Enrollment ID: I20090107000326 |
| Provider Name | Jon Gardner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447264841 PECOS PAC ID: 1850454513 Enrollment ID: I20090107000406 |
| Provider Name | Douglas D Dunham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740204411 PECOS PAC ID: 6608939376 Enrollment ID: I20090107000462 |
| Provider Name | John Shannon |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1982610903 PECOS PAC ID: 4183787740 Enrollment ID: I20090108000654 |
| Provider Name | David Hutton |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1932113347 PECOS PAC ID: 2668535170 Enrollment ID: I20090109000345 |
| Provider Name | Kirk Willard |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1669486072 PECOS PAC ID: 9931263423 Enrollment ID: I20090128000211 |
| Provider Name | Michael J Doherty |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1033299953 PECOS PAC ID: 5799833075 Enrollment ID: I20090423000797 |
| Provider Name | Adam T Zierenberg |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1821202573 PECOS PAC ID: 2668546565 Enrollment ID: I20090803000544 |
| Provider Name | Aaron K Vawter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558489070 PECOS PAC ID: 5890848881 Enrollment ID: I20090810000266 |
| Provider Name | Eric T Brown |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336340603 PECOS PAC ID: 1759421332 Enrollment ID: I20091211000291 |
| Provider Name | Oliver A Batson |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1467548941 PECOS PAC ID: 2163564204 Enrollment ID: I20100127000621 |
| Provider Name | Steven Lewis Goldberg |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548345374 PECOS PAC ID: 8123163169 Enrollment ID: I20100302000866 |
| Provider Name | Jared L Wutzke |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225238207 PECOS PAC ID: 7416081385 Enrollment ID: I20100813000379 |
| Provider Name | Maamoon Tammaa |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1740497908 PECOS PAC ID: 7012031297 Enrollment ID: I20100824001154 |
| Provider Name | Joanne Ln Perez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467643619 PECOS PAC ID: 2264558105 Enrollment ID: I20100928001007 |
| Provider Name | Chelane R Fackenthall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699000901 PECOS PAC ID: 3274727888 Enrollment ID: I20101027001317 |
| Provider Name | Sarabjit Kaur Atwal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881928414 PECOS PAC ID: 4880888072 Enrollment ID: I20101102000188 |
| Provider Name | Joshua Jones |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548361009 PECOS PAC ID: 5395844591 Enrollment ID: I20110107000627 |
| Provider Name | Sepehr Steven Maxood |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1770539991 PECOS PAC ID: 3476730045 Enrollment ID: I20110607000864 |
| Provider Name | Benjamin H Leach |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508053174 PECOS PAC ID: 4880862440 Enrollment ID: I20110726000465 |
| Provider Name | Leah M Basnett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235246091 PECOS PAC ID: 8527237189 Enrollment ID: I20110816000632 |
| Provider Name | Catalina M Draghici |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255524930 PECOS PAC ID: 2961672704 Enrollment ID: I20110902000345 |
| Provider Name | Aidah Esarey |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1285777102 PECOS PAC ID: 9638340532 Enrollment ID: I20110927000006 |
| Provider Name | Dennis E Lenhart |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1881649366 PECOS PAC ID: 5698689255 Enrollment ID: I20110929000081 |
| Provider Name | Jennifer W Leach |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1417165382 PECOS PAC ID: 6507039674 Enrollment ID: I20111105000115 |
| Provider Name | Amy S Martens |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609070929 PECOS PAC ID: 0244405892 Enrollment ID: I20111208000684 |
| Provider Name | Carmelle R Boyd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598032740 PECOS PAC ID: 3274709332 Enrollment ID: I20111220000906 |
| Provider Name | Aixa D Espinosa-morales |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1851449938 PECOS PAC ID: 5092987651 Enrollment ID: I20120202000201 |
| Provider Name | James W Jordan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1417156993 PECOS PAC ID: 3870675002 Enrollment ID: I20120329000427 |
| Provider Name | Michael B Mcmurtry |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750367579 PECOS PAC ID: 8426211087 Enrollment ID: I20120517000266 |
| Provider Name | Nae-hwa Kim |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1699978247 PECOS PAC ID: 6800046830 Enrollment ID: I20121026000614 |
| Provider Name | Hisam S Goueli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639382906 PECOS PAC ID: 3870644776 Enrollment ID: I20121030000555 |
| Provider Name | Catherine M Bjerum |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275616021 PECOS PAC ID: 2365441524 Enrollment ID: I20121108000441 |
| Provider Name | Kortney K Killgore Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023379989 PECOS PAC ID: 5294986469 Enrollment ID: I20121115000623 |
| Provider Name | John R Stoddard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558599654 PECOS PAC ID: 4284886177 Enrollment ID: I20121128000195 |
| Provider Name | Evelyn Martindale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518210319 PECOS PAC ID: 8123270485 Enrollment ID: I20121212000568 |
| Provider Name | Robert Edward Albert Parks |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770581332 PECOS PAC ID: 4183602691 Enrollment ID: I20121228000402 |
| Provider Name | Ravi Sivasankara Menon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326160177 PECOS PAC ID: 2062572142 Enrollment ID: I20130605000091 |
| Provider Name | Benjamin Atkinson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023256237 PECOS PAC ID: 4183802945 Enrollment ID: I20130620000086 |
| Provider Name | Naveen Rawat |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1801137716 PECOS PAC ID: 4183864986 Enrollment ID: I20130627000597 |
| Provider Name | Katherine Therese S Cayetano |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1376741603 PECOS PAC ID: 3870625452 Enrollment ID: I20130627000869 |
| Provider Name | Anitha Raghunath |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1659686509 PECOS PAC ID: 9739320763 Enrollment ID: I20130802000118 |
| Provider Name | Eric R Schwartzkopf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346213238 PECOS PAC ID: 3971407511 Enrollment ID: I20130827000961 |
| Provider Name | Clara L Peck |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1659563526 PECOS PAC ID: 6002985264 Enrollment ID: I20130917000070 |
| Provider Name | Lisa C Rootvik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528371564 PECOS PAC ID: 1557548104 Enrollment ID: I20140102001544 |
| Provider Name | Charles S Hames |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1407823701 PECOS PAC ID: 1456535889 Enrollment ID: I20140228001537 |
| Provider Name | Vincent George Lerma Cunanan |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1538368360 PECOS PAC ID: 6305069030 Enrollment ID: I20140527000234 |
| Provider Name | Kristen Marie Riegert |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1164658209 PECOS PAC ID: 6608091707 Enrollment ID: I20140703001279 |
| Provider Name | Elise C Willis |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1487953683 PECOS PAC ID: 6800011602 Enrollment ID: I20140711001158 |
| Provider Name | Dana T Sineath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962613059 PECOS PAC ID: 3577654086 Enrollment ID: I20140712000134 |
| Provider Name | Jake Harley Choiniere |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578882452 PECOS PAC ID: 4688890155 Enrollment ID: I20140721000051 |
| Provider Name | Lesley N Bobek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922202787 PECOS PAC ID: 0244377802 Enrollment ID: I20141216000708 |
| Provider Name | Kitti Kaiboriboon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1912062035 PECOS PAC ID: 4284731027 Enrollment ID: I20150130000742 |
| Provider Name | Perliveh Melendez Carrera |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1477865798 PECOS PAC ID: 4789823287 Enrollment ID: I20150611002773 |
| Provider Name | Gene R Conley |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1508862335 PECOS PAC ID: 6305944927 Enrollment ID: I20150806010768 |
| Provider Name | Mun Jye Poi |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1750574091 PECOS PAC ID: 9638306525 Enrollment ID: I20150922002031 |
| Provider Name | Eiko Klimant |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1154354967 PECOS PAC ID: 4385618891 Enrollment ID: I20151211000128 |
| Provider Name | Stevie Mazyck |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902835697 PECOS PAC ID: 5092764134 Enrollment ID: I20160303001038 |
| Provider Name | Christopher L Rozelle |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1922295294 PECOS PAC ID: 2860790219 Enrollment ID: I20160418002460 |
| Provider Name | Nathaniel Lee Atkin |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134358344 PECOS PAC ID: 4688828981 Enrollment ID: I20160520001449 |
| Provider Name | Phani Chandra Kantamneni |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1518245497 PECOS PAC ID: 0547551400 Enrollment ID: I20160623001052 |
| Provider Name | Tarvinder Singh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225327091 PECOS PAC ID: 0840505251 Enrollment ID: I20160817001266 |
| Provider Name | Mary J Buriani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114378684 PECOS PAC ID: 4082909536 Enrollment ID: I20160823000354 |
| Provider Name | Raef Madanieh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831471499 PECOS PAC ID: 4486971355 Enrollment ID: I20160922002738 |
| Provider Name | Shristi Kunwar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497043319 PECOS PAC ID: 1355569435 Enrollment ID: I20161024001034 |
| Provider Name | Michael M Marvi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1205054129 PECOS PAC ID: 9436203858 Enrollment ID: I20170221000260 |
| Provider Name | Andrew D Rontal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063657328 PECOS PAC ID: 7911150065 Enrollment ID: I20170223002188 |
| Provider Name | Lisa R Yanase |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1851384937 PECOS PAC ID: 1052343167 Enrollment ID: I20170223002540 |
| Provider Name | Graycen Duffy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851839682 PECOS PAC ID: 4981988607 Enrollment ID: I20170224001065 |
| Provider Name | Ronald A Stiller |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1154396109 PECOS PAC ID: 5092609982 Enrollment ID: I20170228001444 |
| Provider Name | Franchette T Pascual |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245491711 PECOS PAC ID: 6305094889 Enrollment ID: I20170504000698 |
| Provider Name | Yi Mao |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629327986 PECOS PAC ID: 0547538118 Enrollment ID: I20170622002818 |
| Provider Name | Wesley Ablemona |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1881004521 PECOS PAC ID: 7618246851 Enrollment ID: I20170703001851 |
| Provider Name | Melissa R Czapka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376072553 PECOS PAC ID: 8123397247 Enrollment ID: I20170705003483 |
| Provider Name | Joseph David Nickolas Freeburg |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174898381 PECOS PAC ID: 7012224298 Enrollment ID: I20170706002670 |
| Provider Name | Randall J Johnson |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1417375866 PECOS PAC ID: 8426327404 Enrollment ID: I20170706002958 |
| Provider Name | Natasha Sparrow |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326308339 PECOS PAC ID: 9931411600 Enrollment ID: I20170802001726 |
| Provider Name | Corey White |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154610814 PECOS PAC ID: 2961723663 Enrollment ID: I20170811001881 |
| Provider Name | Eric D Prince |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770843658 PECOS PAC ID: 2567752777 Enrollment ID: I20171002003734 |
| Provider Name | Fahim Jafary |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1083659700 PECOS PAC ID: 8820029259 Enrollment ID: I20171030002204 |
| Provider Name | Andrew Meillier |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1033520325 PECOS PAC ID: 1658660402 Enrollment ID: I20171122001960 |
| Provider Name | Kyle B Wiley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1427574417 PECOS PAC ID: 9436416922 Enrollment ID: I20171208002164 |
| Provider Name | Rachelle L Hartman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1245280494 PECOS PAC ID: 6709889405 Enrollment ID: I20171222000570 |
| Provider Name | Joseph Robert Perry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134354244 PECOS PAC ID: 8426285917 Enrollment ID: I20180110002318 |
| Provider Name | Usha K Reddi |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1700998747 PECOS PAC ID: 5294724506 Enrollment ID: I20180110002348 |
| Provider Name | Jose Miguel Alanis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720461502 PECOS PAC ID: 0840554010 Enrollment ID: I20180516001356 |
| Provider Name | Thuan P Nguyen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982086898 PECOS PAC ID: 3870848963 Enrollment ID: I20180613001433 |
| Provider Name | Jennifer Marie Ford |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1609217579 PECOS PAC ID: 9931454998 Enrollment ID: I20180614001499 |
| Provider Name | Abdelrahman Beltagy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013250216 PECOS PAC ID: 0840592572 Enrollment ID: I20180615002091 |
| Provider Name | Mohammed Omar Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659756443 PECOS PAC ID: 8325348758 Enrollment ID: I20180622002247 |
| Provider Name | Christopher John Robert Zita |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1255857132 PECOS PAC ID: 4385990613 Enrollment ID: I20180628002781 |
| Provider Name | Michael C Priddy |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1285996942 PECOS PAC ID: 7719134170 Enrollment ID: I20180716002189 |
| Provider Name | Briana Nicole Maynor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619459815 PECOS PAC ID: 7911250840 Enrollment ID: I20181023002594 |
| Provider Name | Cory Nathaniel Mitchell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275943060 PECOS PAC ID: 0345531935 Enrollment ID: I20181023002927 |
| Provider Name | Arthur C Lee |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1194899419 PECOS PAC ID: 4587844733 Enrollment ID: I20181105003180 |
| Provider Name | Katie D Bartlow |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497291397 PECOS PAC ID: 2365788031 Enrollment ID: I20190117000487 |
| Provider Name | Brett Jared Maynor |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1528493913 PECOS PAC ID: 7315284593 Enrollment ID: I20190125001258 |
| Provider Name | Sawyer Kecki Neiffer |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1760950174 PECOS PAC ID: 0042557274 Enrollment ID: I20190125003082 |
| Provider Name | Rainey Marie Bell |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1942728191 PECOS PAC ID: 3173860285 Enrollment ID: I20190128003342 |
| Provider Name | Cynthia Ann Brown |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1518404722 PECOS PAC ID: 7810234804 Enrollment ID: I20190129003013 |
| Provider Name | Katharine Moranne Carlisle |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1740727775 PECOS PAC ID: 5092052829 Enrollment ID: I20190131002156 |
| Provider Name | Holly Ross Farnam |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1033656665 PECOS PAC ID: 4789921461 Enrollment ID: I20190204002009 |
| Provider Name | Joshua Dale Leatherman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1700170990 PECOS PAC ID: 1850638545 Enrollment ID: I20190204002543 |
| Provider Name | Andrea Marie Gass |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1770029456 PECOS PAC ID: 9931447612 Enrollment ID: I20190205003749 |
| Provider Name | Barbara Karen Struck |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1295030849 PECOS PAC ID: 3577801737 Enrollment ID: I20190213001453 |
| Provider Name | Ricky G Christenson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1255877379 PECOS PAC ID: 9537408703 Enrollment ID: I20190305003543 |
| Provider Name | Jeremy Conklin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1700830882 PECOS PAC ID: 7517109614 Enrollment ID: I20190328002037 |
| Provider Name | Mark Thomas Bernardi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073900536 PECOS PAC ID: 3476818667 Enrollment ID: I20190617001704 |
| Provider Name | Charlotte Ela Watership |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1285903534 PECOS PAC ID: 6002884715 Enrollment ID: I20190625000369 |
| Provider Name | Ian Wade Hockett |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831652072 PECOS PAC ID: 3779818596 Enrollment ID: I20190716000886 |
| Provider Name | Caitlin Joy Layden |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1508274994 PECOS PAC ID: 4183950033 Enrollment ID: I20190730002550 |
| Provider Name | Bennett M Johnson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1629481379 PECOS PAC ID: 5890015689 Enrollment ID: I20190822002035 |
| Provider Name | Kim Sherrin Sahib |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1366882326 PECOS PAC ID: 3072850635 Enrollment ID: I20190826001264 |
| Provider Name | Javier Herrera |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1851359467 PECOS PAC ID: 3274429055 Enrollment ID: I20190827003219 |
| Provider Name | James F Wang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962829093 PECOS PAC ID: 7012232655 Enrollment ID: I20190910002212 |
| Provider Name | Penny R Los |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134789522 PECOS PAC ID: 1456681469 Enrollment ID: I20190917004091 |
| Provider Name | Marcus Taylor Perry |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1740635051 PECOS PAC ID: 7618262080 Enrollment ID: I20190918003188 |
| Provider Name | Dale G Wilson |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1891051314 PECOS PAC ID: 7719122480 Enrollment ID: I20191009003195 |
| Provider Name | Jennifer L Burnett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104475243 PECOS PAC ID: 3870926298 Enrollment ID: I20191125002681 |
| Provider Name | Carson Van Sanford |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1669869574 PECOS PAC ID: 9537471149 Enrollment ID: I20191216000256 |
| Provider Name | Sherri Lynn Klebe |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1689111262 PECOS PAC ID: 8123452513 Enrollment ID: I20191217002719 |
| Provider Name | Amil Rafiq |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1669785804 PECOS PAC ID: 4880812452 Enrollment ID: I20191226001504 |
| Provider Name | Joel Roberts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932634706 PECOS PAC ID: 4385904952 Enrollment ID: I20191226002001 |
| Provider Name | Sarah Elizabeth Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538633656 PECOS PAC ID: 2062848120 Enrollment ID: I20200207002409 |
| Provider Name | William Brian Kuhn |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1548451040 PECOS PAC ID: 6507848025 Enrollment ID: I20200218002105 |
| Provider Name | George Lopez |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1578588752 PECOS PAC ID: 9638172034 Enrollment ID: I20200224000997 |
| Provider Name | Brian James Duke |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1285107748 PECOS PAC ID: 7315286796 Enrollment ID: I20200330001178 |
| Provider Name | Ashley Lavonne Astorga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952881898 PECOS PAC ID: 9234560095 Enrollment ID: I20200511002160 |
| Provider Name | Paul William Suding |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1215944129 PECOS PAC ID: 2264531714 Enrollment ID: I20200514000917 |
| Provider Name | Cicero Running Crane |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770015380 PECOS PAC ID: 3577811926 Enrollment ID: I20200709002257 |
| Provider Name | Helen Z Zhang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053774000 PECOS PAC ID: 6103117619 Enrollment ID: I20200720000436 |
| Provider Name | Navdeep Gill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255783494 PECOS PAC ID: 4981028073 Enrollment ID: I20200722001869 |
| Provider Name | Hanbing Wang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679927784 PECOS PAC ID: 3779907522 Enrollment ID: I20200727001289 |
| Provider Name | Michael V Parmley |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1245674043 PECOS PAC ID: 3072740893 Enrollment ID: I20200812000316 |
| Provider Name | Kyle Yuichi Ogami |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801276571 PECOS PAC ID: 9638471626 Enrollment ID: I20200819003829 |
| Provider Name | Michael Meng Chen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558757757 PECOS PAC ID: 9335424449 Enrollment ID: I20200827002834 |
| Provider Name | Lynn M Kemper |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1154703510 PECOS PAC ID: 1355611625 Enrollment ID: I20200902000126 |
| Provider Name | Derek Ting Yu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1568889731 PECOS PAC ID: 5991068363 Enrollment ID: I20200903003199 |
| Provider Name | Aleksandra Joanna Strugalska |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1700497997 PECOS PAC ID: 1355751686 Enrollment ID: I20201027003387 |
| Provider Name | Taylor Jay Delamarter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184002610 PECOS PAC ID: 2769777275 Enrollment ID: I20201109001195 |
| Provider Name | Harris Esarey |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1942801188 PECOS PAC ID: 7517378805 Enrollment ID: I20201117001627 |
| Provider Name | Helen Goldberg |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1790723666 PECOS PAC ID: 3678535333 Enrollment ID: I20201229000999 |
| Provider Name | Charles T Koon |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1467815886 PECOS PAC ID: 8325385719 Enrollment ID: I20210212002032 |
| Provider Name | Roshan Patel |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1679094239 PECOS PAC ID: 2567878192 Enrollment ID: I20210305002281 |
| Provider Name | Melissa Todhunter Murphy |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1669728648 PECOS PAC ID: 8527474162 Enrollment ID: I20210308000426 |
| Provider Name | John Golden |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1780744268 PECOS PAC ID: 2567512973 Enrollment ID: I20210316000557 |
| Provider Name | Robert J Nachtsheim |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1962490193 PECOS PAC ID: 9133159221 Enrollment ID: I20210331001202 |
| Provider Name | Jose Gomez Bautista |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508354010 PECOS PAC ID: 4587064209 Enrollment ID: I20210616002430 |
| Provider Name | Caroline Anne Arnold |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811492739 PECOS PAC ID: 1456680404 Enrollment ID: I20210712001061 |
| Provider Name | William Lou |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1710340161 PECOS PAC ID: 9830481241 Enrollment ID: I20210723003232 |
| Provider Name | Thomas Edgar |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1942794193 PECOS PAC ID: 3173872744 Enrollment ID: I20210805003126 |
| Provider Name | Donna L Braswell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538357900 PECOS PAC ID: 2961694666 Enrollment ID: I20210901000627 |
| Provider Name | Yvette Rae Hollett |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1750744108 PECOS PAC ID: 6608163217 Enrollment ID: I20210913000190 |
| Provider Name | Hanna Lee |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1225689946 PECOS PAC ID: 4486050523 Enrollment ID: I20210915000341 |
| Provider Name | Jae Won Lee |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1184967150 PECOS PAC ID: 4981914918 Enrollment ID: I20210928000106 |
| Provider Name | Vikas Garg |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1174775951 PECOS PAC ID: 4183849839 Enrollment ID: I20211026002723 |
| Provider Name | Deanne E Bergh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467126276 PECOS PAC ID: 8729477583 Enrollment ID: I20211116002606 |
| Provider Name | Katherine Wyrick |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1609309376 PECOS PAC ID: 2163815739 Enrollment ID: I20220202001869 |
| Provider Name | Stacie N Chance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770133506 PECOS PAC ID: 9032548193 Enrollment ID: I20220224002082 |
| Provider Name | Lian Farino |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386179364 PECOS PAC ID: 9133530769 Enrollment ID: I20220318000182 |
| Provider Name | Bethany F Ray |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497306203 PECOS PAC ID: 0749675171 Enrollment ID: I20220321002127 |
| Provider Name | Conor David Lucas-roberts |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275193625 PECOS PAC ID: 2466830419 Enrollment ID: I20220602001744 |
| Provider Name | Alexandra Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306473202 PECOS PAC ID: 2062891245 Enrollment ID: I20220617001304 |
| Provider Name | Michelle Patrice Wolf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841921277 PECOS PAC ID: 7719367390 Enrollment ID: I20220629003128 |
| Provider Name | Alisha Rye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790307957 PECOS PAC ID: 0345667358 Enrollment ID: I20220712003096 |
| Provider Name | Sri Harika Meka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396307211 PECOS PAC ID: 0244567501 Enrollment ID: I20220725001788 |
| Provider Name | Gagneet Gill |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235790858 PECOS PAC ID: 9133450448 Enrollment ID: I20220726001940 |
| Provider Name | Meghana Srinivas Kinariwala |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1871049809 PECOS PAC ID: 4284904293 Enrollment ID: I20220726003823 |
| Provider Name | Charlo Brandon Crumpacker |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003461823 PECOS PAC ID: 5799014874 Enrollment ID: I20220729002175 |
| Provider Name | Soo Young Kwon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497199210 PECOS PAC ID: 2365686474 Enrollment ID: I20220816003257 |
| Provider Name | Shelby A Reiter |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1477084770 PECOS PAC ID: 1658641998 Enrollment ID: I20220823001490 |
| Provider Name | Michael Roy Moore |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1235132978 PECOS PAC ID: 0840330783 Enrollment ID: I20220921000663 |
| Provider Name | Ian S Gallaher |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1801152160 PECOS PAC ID: 9931405073 Enrollment ID: I20221007002696 |
| Provider Name | Jesse J Styner |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1467172429 PECOS PAC ID: 0042686537 Enrollment ID: I20221025002500 |
| Provider Name | Ana-megan Babin |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1619266145 PECOS PAC ID: 4981073392 Enrollment ID: I20221207000646 |
| Provider Name | Stuart Babcock |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1366463689 PECOS PAC ID: 4880756790 Enrollment ID: I20230116000208 |
| Provider Name | Trisha Leonard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427508233 PECOS PAC ID: 0840579090 Enrollment ID: I20230307000811 |
| Provider Name | Melony Burns |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750047510 PECOS PAC ID: 2163897141 Enrollment ID: I20230404002354 |
| Provider Name | Trisha Leonard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174841571 PECOS PAC ID: 9234504291 Enrollment ID: I20230405002448 |
| Provider Name | Desiray N Anderson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1982300596 PECOS PAC ID: 9739554049 Enrollment ID: I20230418001931 |
| Provider Name | Austin D Hardin |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346946415 PECOS PAC ID: 1254796857 Enrollment ID: I20230504001389 |
| Provider Name | Elizabeth Tomer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053063842 PECOS PAC ID: 9537525936 Enrollment ID: I20230509001903 |
| Provider Name | Seth L. Welborn |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1376907436 PECOS PAC ID: 0042611329 Enrollment ID: I20230804001322 |
| Provider Name | Phuong Nguyen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1275947103 PECOS PAC ID: 1153651161 Enrollment ID: I20230823001966 |
| Provider Name | Keith M Mcnab |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013354885 PECOS PAC ID: 1456652106 Enrollment ID: I20230906002009 |
| Provider Name | Morgan C Galante |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225416266 PECOS PAC ID: 1850717307 Enrollment ID: I20231002000904 |
| Provider Name | Tamara K Sharon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700551892 PECOS PAC ID: 3971958919 Enrollment ID: I20231011003889 |
| Provider Name | Nicholas P Michael |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1891172409 PECOS PAC ID: 1355768979 Enrollment ID: I20231023002943 |
| Provider Name | Amy Beth Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588441042 PECOS PAC ID: 1658720487 Enrollment ID: I20231205003521 |
| Provider Name | Leikin Louise Patrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063293561 PECOS PAC ID: 2264883024 Enrollment ID: I20240105003925 |
| Provider Name | Karl Stuart Tjerandsen |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1487077566 PECOS PAC ID: 2466717475 Enrollment ID: I20240107000022 |
| Provider Name | Rodney Badger |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1003874439 PECOS PAC ID: 2567418494 Enrollment ID: I20240111000383 |
| Provider Name | Andrew J Adams |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1538456413 PECOS PAC ID: 3577855485 Enrollment ID: I20240121000072 |
| Provider Name | John Casey Heffernan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750818019 PECOS PAC ID: 8426479098 Enrollment ID: I20240205001735 |
| Provider Name | Hyunjin Eo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043083959 PECOS PAC ID: 8729421656 Enrollment ID: I20240208000460 |
| Provider Name | Lindsey K Frischmann |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629364419 PECOS PAC ID: 4789970815 Enrollment ID: I20240220002532 |
| Provider Name | Richard Beasley |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1811023625 PECOS PAC ID: 9335307172 Enrollment ID: I20240426002348 |
| Provider Name | Beda Diana Marrero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790547693 PECOS PAC ID: 4082054762 Enrollment ID: I20240429000775 |
Chiildrens Home Society Of Washington Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1612 Penny Lane, Walla Walla, WA 99362 Phone: 509-529-2130 Fax: 509-526-3640 | |
L. Jenae Henry Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1644 Plaza Way # 302, Walla Walla, WA 99362 Phone: 509-876-8065 Fax: 877-560-9702 | |
Switchback Wellness, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 5 W Alder St Ste 342, Walla Walla, WA 99362 Phone: 541-371-2511 Fax: 509-769-5452 | |
Teaming For Success Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 121 W Chestnut St, Walla Walla, WA 99362 Phone: 509-529-5133 Fax: 509-525-3442 | |
Sara Muckler Ma Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1337 Caprio Loop, Walla Walla, WA 99362 Phone: 206-605-6329 | |
Catherine J. Mehn, Licsw Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 W Main St Ste 101, Walla Walla, WA 99362 Phone: 509-301-0476 | |
Zimmerman Counseling Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 W Main St Ste 101, Walla Walla, WA 99362 Phone: 509-876-6987 |