| Ut Medical Group Inc | |
|
1407 Union Ave Ste 700 Memphis TN 38104-3641 | |
| (901) 866-8864 | |
| Not Available |
| Full Name | Ut Medical Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1407 Union Ave Ste 700, Memphis, Tennessee |
| Authorized Official Name and Position | Courtney Love (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Contact | 9018668105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ut Medical Group Inc 1407 Union Ave Ste 700 Memphis TN 38104-3641 Ph: (901) 866-8864 | Ut Medical Group Inc 1407 Union Ave Ste 700 Memphis TN 38104-3641 Ph: (901) 866-8864 |
| NPI Number | 1780676650 |
|---|---|
| Provider Enumeration Date | 08/17/2005 |
| Last Update Date | 04/04/2023 |
| Certification Date | 04/04/2023 |
| Medicare PECOS PAC ID | 3173435369 |
|---|---|
| Medicare Enrollment ID | O20031105000384 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780676650 | NPI | - | NPPES |
| 1530598 | Medicaid | TN | |
| 500425103 | Medicaid | MO | |
| 65906117 | Medicaid | KY | |
| 04721062 | Medicaid | MS | |
| 107355002 | Medicaid | AR | |
| 1780676650 | Medicaid | IL | |
| 154277 | Medicaid | AL |
| Provider Name | Steve T Charles |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1861495780 PECOS PAC ID: 0749193498 Enrollment ID: I20040205000469 |
| Provider Name | Margaret C Hastings |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174544811 PECOS PAC ID: 7517943905 Enrollment ID: I20040626000117 |
| Provider Name | Arif Showkat |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1942268529 PECOS PAC ID: 0446223242 Enrollment ID: I20040819000201 |
| Provider Name | Matthew W Wilson |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1104883701 PECOS PAC ID: 1456305994 Enrollment ID: I20050308001068 |
| Provider Name | Burton L Hayes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497712368 PECOS PAC ID: 7517908981 Enrollment ID: I20050516000723 |
| Provider Name | Robert B Canada |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033176250 PECOS PAC ID: 1759390628 Enrollment ID: I20060420000583 |
| Provider Name | Ramasubbareddy Dhanireddy |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1144287863 PECOS PAC ID: 5597778258 Enrollment ID: I20060724000342 |
| Provider Name | Elliott M Kanner |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1477636033 PECOS PAC ID: 1951302686 Enrollment ID: I20070124000250 |
| Provider Name | Jie Zhang |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1629106281 PECOS PAC ID: 7719072578 Enrollment ID: I20071009000405 |
| Provider Name | Mohamad El-abiad |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346463130 PECOS PAC ID: 4789770009 Enrollment ID: I20071018000255 |
| Provider Name | James E Gardner |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1801009089 PECOS PAC ID: 2668410002 Enrollment ID: I20071109000254 |
| Provider Name | Muhammad S Siddiq |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1124113832 PECOS PAC ID: 5890883375 Enrollment ID: I20071119000202 |
| Provider Name | David W Peeler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467567867 PECOS PAC ID: 3577649011 Enrollment ID: I20080327000717 |
| Provider Name | Jesse M Wesberry |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1285720672 PECOS PAC ID: 1153490867 Enrollment ID: I20080521000502 |
| Provider Name | Bryan K Darling |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1114083490 PECOS PAC ID: 4880758234 Enrollment ID: I20090129000209 |
| Provider Name | Patrick W Omara |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467509331 PECOS PAC ID: 5496640260 Enrollment ID: I20090129000219 |
| Provider Name | Renee M Bowen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952574097 PECOS PAC ID: 1850442088 Enrollment ID: I20090630000296 |
| Provider Name | Ramesh K M Krishnan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992732580 PECOS PAC ID: 5193754448 Enrollment ID: I20091002000286 |
| Provider Name | Shelley R Ost |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588862445 PECOS PAC ID: 8729127436 Enrollment ID: I20091209000037 |
| Provider Name | Milton B Randall |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1124002175 PECOS PAC ID: 3375672272 Enrollment ID: I20100603000038 |
| Provider Name | Divya Rana |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477757912 PECOS PAC ID: 8527190537 Enrollment ID: I20100709000216 |
| Provider Name | Ronald L Cowan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912094020 PECOS PAC ID: 5597881300 Enrollment ID: I20100929001426 |
| Provider Name | Massroor Pourcyrous |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386601821 PECOS PAC ID: 4587856455 Enrollment ID: I20101011000529 |
| Provider Name | Ajay J Talati |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447217922 PECOS PAC ID: 7214129105 Enrollment ID: I20101011000654 |
| Provider Name | Natascha S Thompson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386600567 PECOS PAC ID: 8729270343 Enrollment ID: I20101014000005 |
| Provider Name | Robert D Wallace |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1023075637 PECOS PAC ID: 6608068234 Enrollment ID: I20101014000191 |
| Provider Name | Brian N Kiel |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1316931272 PECOS PAC ID: 3375441546 Enrollment ID: I20101015000756 |
| Provider Name | David Moinester |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1386639789 PECOS PAC ID: 9335262278 Enrollment ID: I20101129000382 |
| Provider Name | Iverson C Bell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073529046 PECOS PAC ID: 9739105628 Enrollment ID: I20101229000526 |
| Provider Name | Omer Asif Siddiqui |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1659577278 PECOS PAC ID: 6305030768 Enrollment ID: I20110616000804 |
| Provider Name | Muneeza Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679736094 PECOS PAC ID: 7911175344 Enrollment ID: I20110729000191 |
| Provider Name | Laura Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881719938 PECOS PAC ID: 0941471478 Enrollment ID: I20110914000047 |
| Provider Name | Brian T Fowler |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1093987893 PECOS PAC ID: 5092970418 Enrollment ID: I20120709000655 |
| Provider Name | Hieu Vo |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1689807455 PECOS PAC ID: 0941457360 Enrollment ID: I20120820001015 |
| Provider Name | Csaba Pal Kovesdy |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1477553022 PECOS PAC ID: 2961439914 Enrollment ID: I20120910000644 |
| Provider Name | Cyrilyn A Walters |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487867487 PECOS PAC ID: 2264680578 Enrollment ID: I20120911000725 |
| Provider Name | Sonia M Alvarez |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1952543084 PECOS PAC ID: 7214186188 Enrollment ID: I20121009000632 |
| Provider Name | Farrukh I Gill |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1992949309 PECOS PAC ID: 9739339110 Enrollment ID: I20121025000424 |
| Provider Name | Tejesh Patel |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1649493123 PECOS PAC ID: 8123273380 Enrollment ID: I20130220000054 |
| Provider Name | Helmut O Steinberg |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1467417246 PECOS PAC ID: 1557508207 Enrollment ID: I20130516000429 |
| Provider Name | Sandeep Chilakala |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1487835229 PECOS PAC ID: 6608014352 Enrollment ID: I20130607000549 |
| Provider Name | Mimily Harsono |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1003137571 PECOS PAC ID: 5799925467 Enrollment ID: I20130701000816 |
| Provider Name | Asif Saeed Kazmi |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1750501623 PECOS PAC ID: 8628148236 Enrollment ID: I20130718000636 |
| Provider Name | Emily H Jones |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1962644039 PECOS PAC ID: 0840431722 Enrollment ID: I20130719000369 |
| Provider Name | Brian M Jerkins |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1487829347 PECOS PAC ID: 8426213810 Enrollment ID: I20130723001046 |
| Provider Name | Mark F Weems |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477793362 PECOS PAC ID: 9133361942 Enrollment ID: I20130807000593 |
| Provider Name | Paul B Hill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740283910 PECOS PAC ID: 9234325903 Enrollment ID: I20130925000848 |
| Provider Name | Jonathan L Altomar |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306005905 PECOS PAC ID: 1557415965 Enrollment ID: I20131028001876 |
| Provider Name | Andrei V Alexandrov |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1861526915 PECOS PAC ID: 8426029422 Enrollment ID: I20140305002134 |
| Provider Name | Paula Decrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558771956 PECOS PAC ID: 8325264559 Enrollment ID: I20140724001589 |
| Provider Name | Seung-jae Texas Song |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1922388206 PECOS PAC ID: 7315163136 Enrollment ID: I20140730002180 |
| Provider Name | Marc D Malkoff |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1477660306 PECOS PAC ID: 8426003799 Enrollment ID: I20140805001252 |
| Provider Name | Petros Konofaos |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1720364367 PECOS PAC ID: 2264659895 Enrollment ID: I20140805002773 |
| Provider Name | Stephen M Huddleston |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1992022800 PECOS PAC ID: 3476790940 Enrollment ID: I20140815001131 |
| Provider Name | Jennifer M Davidson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659638310 PECOS PAC ID: 0345460986 Enrollment ID: I20141003000072 |
| Provider Name | Leslie E Lopez-calderon |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1508005570 PECOS PAC ID: 5890945091 Enrollment ID: I20141015001012 |
| Provider Name | John Purvis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134121783 PECOS PAC ID: 4981770237 Enrollment ID: I20141029002583 |
| Provider Name | Victoria M Swatzell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457544033 PECOS PAC ID: 9335467950 Enrollment ID: I20150410002425 |
| Provider Name | Khalid A Alsherbini |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1720309248 PECOS PAC ID: 8921242108 Enrollment ID: I20150804005982 |
| Provider Name | Kwame E Torgbe |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1730318718 PECOS PAC ID: 9436470333 Enrollment ID: I20151028000671 |
| Provider Name | Pamela Jean Sanders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265892749 PECOS PAC ID: 6709182264 Enrollment ID: I20160309000677 |
| Provider Name | Khyati Kothari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801102330 PECOS PAC ID: 7214152610 Enrollment ID: I20160407001415 |
| Provider Name | Wendy Lynn Dusenbury |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447255526 PECOS PAC ID: 1850394800 Enrollment ID: I20160718001046 |
| Provider Name | Katherine I Nearing |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073807970 PECOS PAC ID: 4789977984 Enrollment ID: I20160726001786 |
| Provider Name | Monica Juma |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780027144 PECOS PAC ID: 9436397122 Enrollment ID: I20160803001519 |
| Provider Name | Hemanth Veluswamy |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1356575492 PECOS PAC ID: 6608009295 Enrollment ID: I20160809000732 |
| Provider Name | Sai Ramakrishna Velamuri Venkata |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1962631341 PECOS PAC ID: 3577857754 Enrollment ID: I20160810002608 |
| Provider Name | Parul G Zaveri |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1326326075 PECOS PAC ID: 4082916416 Enrollment ID: I20160831000719 |
| Provider Name | Anne W Alexandrov |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447605753 PECOS PAC ID: 4082900642 Enrollment ID: I20160907002096 |
| Provider Name | Logan Key |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891109088 PECOS PAC ID: 3375839764 Enrollment ID: I20160912000947 |
| Provider Name | David Louis Schwartz |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1922104157 PECOS PAC ID: 8921070574 Enrollment ID: I20160927000148 |
| Provider Name | Hallie Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497204960 PECOS PAC ID: 8022396142 Enrollment ID: I20161025000776 |
| Provider Name | Allison Vaughan Jones |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1699119719 PECOS PAC ID: 4082854526 Enrollment ID: I20170912000368 |
| Provider Name | Christina Brown Tran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003236217 PECOS PAC ID: 5991929119 Enrollment ID: I20170926001656 |
| Provider Name | Sanjeet V Rangarajan |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1649568395 PECOS PAC ID: 9537396890 Enrollment ID: I20171009002732 |
| Provider Name | Vaishnavi Reddy Pulusani |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1164789533 PECOS PAC ID: 4486893153 Enrollment ID: I20171019003305 |
| Provider Name | Abigael N Maxwell |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1801171129 PECOS PAC ID: 6305132895 Enrollment ID: I20171115002157 |
| Provider Name | Lauren C King |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1518130996 PECOS PAC ID: 4486890456 Enrollment ID: I20171129000789 |
| Provider Name | Ashley Nicolle Matthews |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245650803 PECOS PAC ID: 1153541768 Enrollment ID: I20180124000751 |
| Provider Name | Denis Alemka Foretia |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1487814257 PECOS PAC ID: 8022322544 Enrollment ID: I20180525001766 |
| Provider Name | Balaji Krishnaiah |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770825283 PECOS PAC ID: 1658652656 Enrollment ID: I20180723001262 |
| Provider Name | Amber Leigh Thacker |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770903882 PECOS PAC ID: 5991056319 Enrollment ID: I20180925001780 |
| Provider Name | Nour M Yadak |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1215292594 PECOS PAC ID: 4880832724 Enrollment ID: I20181008001872 |
| Provider Name | Charlie Busby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679950679 PECOS PAC ID: 8729309422 Enrollment ID: I20181024001193 |
| Provider Name | Syed Raza |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1992903157 PECOS PAC ID: 0840434106 Enrollment ID: I20181204003136 |
| Provider Name | William Haywood Mays |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265690580 PECOS PAC ID: 1759626799 Enrollment ID: I20181220000740 |
| Provider Name | Rateesha Quintale Mcleod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306316997 PECOS PAC ID: 9032455316 Enrollment ID: I20190108000242 |
| Provider Name | Mahmoud Salhab |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154762458 PECOS PAC ID: 0446486864 Enrollment ID: I20190108002217 |
| Provider Name | Scott Eric Strome |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1457368771 PECOS PAC ID: 7315984226 Enrollment ID: I20190131000293 |
| Provider Name | Mahwash Kamal |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1104112283 PECOS PAC ID: 1759508971 Enrollment ID: I20190304000438 |
| Provider Name | Vineet Lamba |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255772588 PECOS PAC ID: 5092041681 Enrollment ID: I20190719000016 |
| Provider Name | Glenn Paul Murray |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1669890935 PECOS PAC ID: 9739437062 Enrollment ID: I20190727000420 |
| Provider Name | Raj D Dedhia |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1457767451 PECOS PAC ID: 3476880741 Enrollment ID: I20190808002866 |
| Provider Name | Twisha H Oza |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1417378845 PECOS PAC ID: 7810234390 Enrollment ID: I20190830002379 |
| Provider Name | Lindsey Adams |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1871944793 PECOS PAC ID: 8628362035 Enrollment ID: I20191008002910 |
| Provider Name | Whitney Shroyer |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1619313756 PECOS PAC ID: 3577703255 Enrollment ID: I20191008003358 |
| Provider Name | Mark N Rubin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1104055169 PECOS PAC ID: 9931394491 Enrollment ID: I20191008004013 |
| Provider Name | Alice Chedid |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1790191856 PECOS PAC ID: 5799054896 Enrollment ID: I20191008004016 |
| Provider Name | Silpa Peravali |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366748055 PECOS PAC ID: 0345475919 Enrollment ID: I20191009002961 |
| Provider Name | Brittany R Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174171532 PECOS PAC ID: 8527390335 Enrollment ID: I20191029000553 |
| Provider Name | Zeinab A Hasan |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1205279270 PECOS PAC ID: 7214252956 Enrollment ID: I20191108002979 |
| Provider Name | Mary Samantha Jones |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1699162354 PECOS PAC ID: 9739400870 Enrollment ID: I20191220001929 |
| Provider Name | Mariantonieta Tirado Gonzalez |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1396025060 PECOS PAC ID: 8224469143 Enrollment ID: I20200509000019 |
| Provider Name | Stephen A Ashe |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1639532823 PECOS PAC ID: 5698061646 Enrollment ID: I20200804003565 |
| Provider Name | Ferrell Varner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619321635 PECOS PAC ID: 0143645366 Enrollment ID: I20200805002225 |
| Provider Name | Benjamin King |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1871937870 PECOS PAC ID: 2163662545 Enrollment ID: I20200806000870 |
| Provider Name | Claire Wright |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1184010308 PECOS PAC ID: 6608170972 Enrollment ID: I20200813003839 |
| Provider Name | Samantha Howard Caldwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114459500 PECOS PAC ID: 5395015176 Enrollment ID: I20200901002219 |
| Provider Name | Karis Linette Browder |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730590076 PECOS PAC ID: 9234559915 Enrollment ID: I20201019001931 |
| Provider Name | William C Cushman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902905722 PECOS PAC ID: 6709189822 Enrollment ID: I20201022000771 |
| Provider Name | Callie R Dugard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245845247 PECOS PAC ID: 3072933498 Enrollment ID: I20201022003863 |
| Provider Name | Salar Rafieetary |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1174052237 PECOS PAC ID: 7315347754 Enrollment ID: I20210608002346 |
| Provider Name | Bhuvaneshwari Jagadesan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255713954 PECOS PAC ID: 3274848411 Enrollment ID: I20210623001981 |
| Provider Name | Carey Burton Wood |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1386030666 PECOS PAC ID: 8729380878 Enrollment ID: I20210723001111 |
| Provider Name | Keadrea R Wilson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912392572 PECOS PAC ID: 4183027048 Enrollment ID: I20210729001997 |
| Provider Name | Xiangxia Liu |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1427403278 PECOS PAC ID: 2466841788 Enrollment ID: I20211108001317 |
| Provider Name | Anas Eid |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1285908509 PECOS PAC ID: 5799174801 Enrollment ID: I20211111000679 |
| Provider Name | Cheran Elangovan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1124479704 PECOS PAC ID: 9638462013 Enrollment ID: I20220103000432 |
| Provider Name | Fatima Mir |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1548645799 PECOS PAC ID: 3274825880 Enrollment ID: I20220106000085 |
| Provider Name | Haley Nicole Zamora |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275290173 PECOS PAC ID: 2961895735 Enrollment ID: I20220131002623 |
| Provider Name | Nicole Haney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528726627 PECOS PAC ID: 3678966280 Enrollment ID: I20220209002172 |
| Provider Name | Mahmoud Hassouba |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1437534682 PECOS PAC ID: 6204229412 Enrollment ID: I20220211000665 |
| Provider Name | Olivia Mallory Delozier |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1225418668 PECOS PAC ID: 2860703576 Enrollment ID: I20220328000007 |
| Provider Name | Rishika Sakaria |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710337936 PECOS PAC ID: 8527351048 Enrollment ID: I20220503000558 |
| Provider Name | Donald Keith Mccown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851049951 PECOS PAC ID: 7911385372 Enrollment ID: I20220526000980 |
| Provider Name | Devra Beyer Becker |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1831254127 PECOS PAC ID: 3274608989 Enrollment ID: I20220603000617 |
| Provider Name | Megan Derrer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1942687801 PECOS PAC ID: 4284949983 Enrollment ID: I20220609000056 |
| Provider Name | Priscilla Lao |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1033571088 PECOS PAC ID: 5991076739 Enrollment ID: I20220812001961 |
| Provider Name | Joseph Fong |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1386177574 PECOS PAC ID: 6800165119 Enrollment ID: I20220821000149 |
| Provider Name | Amy Biedenbach |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1932298429 PECOS PAC ID: 0345204962 Enrollment ID: I20220912000593 |
| Provider Name | Stefania Baccino |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710474655 PECOS PAC ID: 9436414646 Enrollment ID: I20221026000046 |
| Provider Name | Juan J Goyanes-vasquez |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1831622968 PECOS PAC ID: 7113398728 Enrollment ID: I20230118001951 |
| Provider Name | Abebech Waktola |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1942720552 PECOS PAC ID: 1052656493 Enrollment ID: I20230314000580 |
| Provider Name | Robin Evans |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1649740424 PECOS PAC ID: 3375972128 Enrollment ID: I20230419003192 |
| Provider Name | Alicia Barnes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720364086 PECOS PAC ID: 2961784665 Enrollment ID: I20230502002091 |
| Provider Name | Wesley Gillette |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1811552045 PECOS PAC ID: 9739413279 Enrollment ID: I20230523003051 |
| Provider Name | Carol Harden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720617616 PECOS PAC ID: 6103257647 Enrollment ID: I20230726003024 |
| Provider Name | Omar Saeed |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1477059756 PECOS PAC ID: 7719234335 Enrollment ID: I20230801003091 |
| Provider Name | Jonathan Glaze |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1821551714 PECOS PAC ID: 3971832932 Enrollment ID: I20230802001267 |
| Provider Name | Ashley Newsome |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306409966 PECOS PAC ID: 6103157243 Enrollment ID: I20230802001869 |
| Provider Name | Srinidhi Reddy Pulusani |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1215490644 PECOS PAC ID: 9739540949 Enrollment ID: I20230804000486 |
| Provider Name | Saji Bushnaq |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1720502842 PECOS PAC ID: 3173895497 Enrollment ID: I20230817001230 |
| Provider Name | Kelsey Ray Bastian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710546213 PECOS PAC ID: 8921460247 Enrollment ID: I20230817001787 |
| Provider Name | Matthew Cook |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1144783374 PECOS PAC ID: 8820325558 Enrollment ID: I20230818000309 |
| Provider Name | Constance Fry |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1306804273 PECOS PAC ID: 1456359694 Enrollment ID: I20230824001063 |
| Provider Name | Crystal Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851070817 PECOS PAC ID: 6204282478 Enrollment ID: I20231024002281 |
| Provider Name | Dani Kruchevsky |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1063123016 PECOS PAC ID: 9234585076 Enrollment ID: I20231030003573 |
| Provider Name | Joya Sahu |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1548471071 PECOS PAC ID: 0547430787 Enrollment ID: I20231229002665 |
| Provider Name | Hae Won Shin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1760665327 PECOS PAC ID: 7113190794 Enrollment ID: I20240105003685 |
| Provider Name | Edson Ruiz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1013406008 PECOS PAC ID: 5698115418 Enrollment ID: I20240426002505 |
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