| Boone Physician Services, Llc | |
|
1600 E Broadway Columbia MO 65201-5844 | |
| (573) 815-6245 | |
| (573) 815-8556 |
| Full Name | Boone Physician Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1600 E Broadway, Columbia, Missouri |
| Authorized Official Name and Position | Brian Lee Winn (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 5738153269 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boone Physician Services, Llc 1600 E Broadway Columbia MO 65201-5844 Ph: (573) 815-6245 | Boone Physician Services, Llc 1600 E Broadway Columbia MO 65201-5844 Ph: (573) 815-6245 |
| NPI Number | 1760893259 |
|---|---|
| Provider Enumeration Date | 05/19/2014 |
| Last Update Date | 03/15/2021 |
| Medicare PECOS PAC ID | 6507090644 |
|---|---|
| Medicare Enrollment ID | O20131003000535 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760893259 | NPI | - | NPPES |
| DU1604 | Other | MO | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Carlin A Ridpath |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497715080 PECOS PAC ID: 3870406697 Enrollment ID: I20031107000570 |
| Provider Name | Michael T Kinkade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588774889 PECOS PAC ID: 3678468329 Enrollment ID: I20040220000297 |
| Provider Name | Paul Santiago |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1114945540 PECOS PAC ID: 1052304375 Enrollment ID: I20040405000387 |
| Provider Name | Michele L Williams |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1629074703 PECOS PAC ID: 0244227031 Enrollment ID: I20040426000826 |
| Provider Name | Katherine Batton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932105384 PECOS PAC ID: 6800884123 Enrollment ID: I20040505000459 |
| Provider Name | Florence F Doman |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1699702035 PECOS PAC ID: 6800844473 Enrollment ID: I20050111000013 |
| Provider Name | Donald J Meyer |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1912990805 PECOS PAC ID: 6507816493 Enrollment ID: I20050214000189 |
| Provider Name | John A Kesler |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1710070784 PECOS PAC ID: 3577506245 Enrollment ID: I20050603000233 |
| Provider Name | Alicia Lange |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1871511154 PECOS PAC ID: 2961446794 Enrollment ID: I20050614000003 |
| Provider Name | Cedric C Strange |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174538730 PECOS PAC ID: 5193760569 Enrollment ID: I20050812000401 |
| Provider Name | Andrew S Youkilis |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1740244813 PECOS PAC ID: 4284664780 Enrollment ID: I20050815000697 |
| Provider Name | Paul E Bernabe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205835303 PECOS PAC ID: 3375583420 Enrollment ID: I20050912000003 |
| Provider Name | Maria Bernabe |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1235138330 PECOS PAC ID: 7810929809 Enrollment ID: I20050912000007 |
| Provider Name | Huan L Nguyen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306852371 PECOS PAC ID: 8224084264 Enrollment ID: I20051026001065 |
| Provider Name | James J Borders |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588670913 PECOS PAC ID: 6901896885 Enrollment ID: I20051027000360 |
| Provider Name | Christopher T Russell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902812613 PECOS PAC ID: 7315917986 Enrollment ID: I20051031001009 |
| Provider Name | Frederick D Harris |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1124034657 PECOS PAC ID: 3577580299 Enrollment ID: I20051130000919 |
| Provider Name | Maxwell Lazinger |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306833405 PECOS PAC ID: 5193746188 Enrollment ID: I20051219000476 |
| Provider Name | Terry Jean Elwing |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346237435 PECOS PAC ID: 7416979406 Enrollment ID: I20051219000525 |
| Provider Name | Shane T Smith |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1215968110 PECOS PAC ID: 2163444316 Enrollment ID: I20060206000038 |
| Provider Name | Kimberly A Kritzer |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1245261601 PECOS PAC ID: 0345259586 Enrollment ID: I20060417000107 |
| Provider Name | Robin V Aguilar |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1245288513 PECOS PAC ID: 9436148459 Enrollment ID: I20060417000468 |
| Provider Name | Lindsay A Bell |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1104874833 PECOS PAC ID: 6608887831 Enrollment ID: I20060531000220 |
| Provider Name | Terrence J Ryan |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1619925559 PECOS PAC ID: 2860404274 Enrollment ID: I20060630000135 |
| Provider Name | Charles P Bondurant |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1174515696 PECOS PAC ID: 2365454774 Enrollment ID: I20060630000171 |
| Provider Name | Todd M Ankenman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1386675676 PECOS PAC ID: 7315940434 Enrollment ID: I20060815000121 |
| Provider Name | Shaon D Fry |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558380659 PECOS PAC ID: 8224031349 Enrollment ID: I20060815000352 |
| Provider Name | Nathaniel G Murphey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720025307 PECOS PAC ID: 6800899634 Enrollment ID: I20060817000371 |
| Provider Name | Anne E Petersen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1114968435 PECOS PAC ID: 5799788261 Enrollment ID: I20060823000286 |
| Provider Name | Richard Kenneth Capling |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1265450217 PECOS PAC ID: 4183667058 Enrollment ID: I20060912000482 |
| Provider Name | Timothy R Soncasie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225058308 PECOS PAC ID: 9234134834 Enrollment ID: I20061003000174 |
| Provider Name | Holly M Boyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801985833 PECOS PAC ID: 5991706921 Enrollment ID: I20070118000150 |
| Provider Name | Paula J Mcmurtry |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1568467546 PECOS PAC ID: 7214030485 Enrollment ID: I20070308000005 |
| Provider Name | Lance C Faler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073558177 PECOS PAC ID: 7618072844 Enrollment ID: I20070418000013 |
| Provider Name | Michael L Quinlan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134122906 PECOS PAC ID: 7810094190 Enrollment ID: I20070601000426 |
| Provider Name | Siamac Vahabzadeh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568536514 PECOS PAC ID: 5890894893 Enrollment ID: I20070615000127 |
| Provider Name | Redonda Marshall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275599615 PECOS PAC ID: 1759480478 Enrollment ID: I20070621000176 |
| Provider Name | Ronald R Renard |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164591921 PECOS PAC ID: 0042310666 Enrollment ID: I20070712000041 |
| Provider Name | Justin A Malone |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1689895534 PECOS PAC ID: 6406948439 Enrollment ID: I20070822001247 |
| Provider Name | Kevin D Halsey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942268206 PECOS PAC ID: 5698867125 Enrollment ID: I20070828000797 |
| Provider Name | Jane A Vaughan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699750091 PECOS PAC ID: 6204924558 Enrollment ID: I20071120000297 |
| Provider Name | Elaine I Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477733806 PECOS PAC ID: 4587747191 Enrollment ID: I20080205000637 |
| Provider Name | Megha Garg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871695049 PECOS PAC ID: 9234213075 Enrollment ID: I20080303000656 |
| Provider Name | Kelly Nickelson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1871780155 PECOS PAC ID: 1759467723 Enrollment ID: I20080401000223 |
| Provider Name | Christopher P Murdock |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366644163 PECOS PAC ID: 5092887752 Enrollment ID: I20080712000063 |
| Provider Name | Andrew J Getzoff |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538157755 PECOS PAC ID: 1052484326 Enrollment ID: I20080718000649 |
| Provider Name | Jeffrey R Wichman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619179991 PECOS PAC ID: 6507959566 Enrollment ID: I20080722000028 |
| Provider Name | Jennifer L Epperson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1356513667 PECOS PAC ID: 8123191947 Enrollment ID: I20080725000710 |
| Provider Name | Mark L Gates |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992711006 PECOS PAC ID: 3678532017 Enrollment ID: I20080829000374 |
| Provider Name | Mark L Pfautsch |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538175203 PECOS PAC ID: 0042279481 Enrollment ID: I20080829000383 |
| Provider Name | George A Pjura |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104831833 PECOS PAC ID: 9638073034 Enrollment ID: I20080829000390 |
| Provider Name | Theodore R Swartz |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588670178 PECOS PAC ID: 7719888197 Enrollment ID: I20080829000410 |
| Provider Name | Shahbaz A Riaz |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1992952113 PECOS PAC ID: 9436227444 Enrollment ID: I20081003000564 |
| Provider Name | Ricardo A Hernandez |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1225191380 PECOS PAC ID: 2668531955 Enrollment ID: I20081031000044 |
| Provider Name | Derek L Fimmen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952524449 PECOS PAC ID: 1456458314 Enrollment ID: I20090330000509 |
| Provider Name | Robin B Blount |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1992772578 PECOS PAC ID: 6002965464 Enrollment ID: I20090514000511 |
| Provider Name | Carolle Silney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922172956 PECOS PAC ID: 4082780564 Enrollment ID: I20090605000168 |
| Provider Name | Justin R Hodge |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073776407 PECOS PAC ID: 5395896963 Enrollment ID: I20090701000284 |
| Provider Name | Arthur R Petrie |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1316064595 PECOS PAC ID: 0042375370 Enrollment ID: I20090721000178 |
| Provider Name | Scott T Graham |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750300497 PECOS PAC ID: 9638223928 Enrollment ID: I20090820000864 |
| Provider Name | Donnetta L Wilkerson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1508094251 PECOS PAC ID: 7719024488 Enrollment ID: I20091029000030 |
| Provider Name | Kurtis L Lackland |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1316271679 PECOS PAC ID: 2961540422 Enrollment ID: I20091104000088 |
| Provider Name | George Prica |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578637567 PECOS PAC ID: 9638245111 Enrollment ID: I20091217000105 |
| Provider Name | Richard J Mellitt |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1730171026 PECOS PAC ID: 4385785542 Enrollment ID: I20100109000281 |
| Provider Name | Denise Jean Freidel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154441822 PECOS PAC ID: 6901881176 Enrollment ID: I20100201000763 |
| Provider Name | Peggy Wanner-barjenbruch |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326023185 PECOS PAC ID: 8921019571 Enrollment ID: I20100305000085 |
| Provider Name | Lisa M Byrd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013140847 PECOS PAC ID: 9830226935 Enrollment ID: I20100421000744 |
| Provider Name | Rebecca Kelley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023099579 PECOS PAC ID: 4385554658 Enrollment ID: I20100524000534 |
| Provider Name | Myles B Goble |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013028745 PECOS PAC ID: 3274666086 Enrollment ID: I20100730000506 |
| Provider Name | Megan D Forsee |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891009353 PECOS PAC ID: 4082739230 Enrollment ID: I20100913000397 |
| Provider Name | Michael R Chicoine |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1346268984 PECOS PAC ID: 3678698644 Enrollment ID: I20100914000828 |
| Provider Name | Linda Jill Gamlin |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1770770059 PECOS PAC ID: 1658467832 Enrollment ID: I20100917000718 |
| Provider Name | Byron T Critchfield |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1396727467 PECOS PAC ID: 5395861587 Enrollment ID: I20100924000835 |
| Provider Name | Marikay L Asberry |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699724351 PECOS PAC ID: 6507058393 Enrollment ID: I20101012000839 |
| Provider Name | Joshua Charles Frates |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1912227190 PECOS PAC ID: 4183817653 Enrollment ID: I20101018000681 |
| Provider Name | Sheena Jose |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710055389 PECOS PAC ID: 6507998424 Enrollment ID: I20110322000776 |
| Provider Name | Terrence M Chambers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972798833 PECOS PAC ID: 9537200365 Enrollment ID: I20110617000551 |
| Provider Name | Tonya A Linthacum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972636686 PECOS PAC ID: 4789852229 Enrollment ID: I20110727000532 |
| Provider Name | James M Koch |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164625794 PECOS PAC ID: 5193994796 Enrollment ID: I20110817000279 |
| Provider Name | Lisa Marie Prather Rollison |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1417111337 PECOS PAC ID: 8527238492 Enrollment ID: I20110901000171 |
| Provider Name | Venkata Kenguva |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497911374 PECOS PAC ID: 1456523612 Enrollment ID: I20111012000030 |
| Provider Name | Rodney C Brownell |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750325908 PECOS PAC ID: 5395787006 Enrollment ID: I20111219000038 |
| Provider Name | Rebecca K Hornbeck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326346685 PECOS PAC ID: 5193986586 Enrollment ID: I20120411000567 |
| Provider Name | Jessica M Bender |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1669670659 PECOS PAC ID: 6406019306 Enrollment ID: I20120511000241 |
| Provider Name | Sara M Revelle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124104831 PECOS PAC ID: 9335302264 Enrollment ID: I20120511000556 |
| Provider Name | Rachel B Hanson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1548539414 PECOS PAC ID: 3072777580 Enrollment ID: I20120613000681 |
| Provider Name | Todd M Buersmeyer |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1487858676 PECOS PAC ID: 2365611852 Enrollment ID: I20120619000064 |
| Provider Name | Joss Fernandez |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1235173642 PECOS PAC ID: 5395748875 Enrollment ID: I20120709000389 |
| Provider Name | Alexandre Makarian |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1639321045 PECOS PAC ID: 7618123407 Enrollment ID: I20120810000030 |
| Provider Name | David T James |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1033398771 PECOS PAC ID: 0941355697 Enrollment ID: I20120816000084 |
| Provider Name | Jason A Goodin |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1629165436 PECOS PAC ID: 4587810049 Enrollment ID: I20120816000099 |
| Provider Name | Adnan Z Choudhury |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1669603486 PECOS PAC ID: 6507013679 Enrollment ID: I20120823000925 |
| Provider Name | Cheryl J Cawley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750402525 PECOS PAC ID: 5496901142 Enrollment ID: I20120905000081 |
| Provider Name | Michael Dewayne Roach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740592435 PECOS PAC ID: 7719153279 Enrollment ID: I20121002000775 |
| Provider Name | Rahul Shekhar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184854663 PECOS PAC ID: 6709035405 Enrollment ID: I20121011000885 |
| Provider Name | Brandon J Glasgow |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063775997 PECOS PAC ID: 2466602958 Enrollment ID: I20121018000045 |
| Provider Name | Melissa Renee Koga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922356294 PECOS PAC ID: 1759532385 Enrollment ID: I20121108000100 |
| Provider Name | Rafael Marroquin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740419431 PECOS PAC ID: 3476704354 Enrollment ID: I20121127000681 |
| Provider Name | Elizabeth A Crews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710232905 PECOS PAC ID: 9830341593 Enrollment ID: I20121204000521 |
| Provider Name | Jacqueline Lea Beshears |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710239033 PECOS PAC ID: 9133372758 Enrollment ID: I20130110000277 |
| Provider Name | Mohammed A Ahmed |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1538443791 PECOS PAC ID: 7315112992 Enrollment ID: I20130604000301 |
| Provider Name | Cathy J Cody |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225349111 PECOS PAC ID: 9830339704 Enrollment ID: I20130717000707 |
| Provider Name | Michael E Thomas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154501393 PECOS PAC ID: 7810168069 Enrollment ID: I20130806000805 |
| Provider Name | Aaron J Whiting |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225359573 PECOS PAC ID: 2860635356 Enrollment ID: I20130903000107 |
| Provider Name | Sonya S Addison |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1215199369 PECOS PAC ID: 3072756287 Enrollment ID: I20130906000359 |
| Provider Name | Catherine A Scheulen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1710326210 PECOS PAC ID: 7113151614 Enrollment ID: I20131017000317 |
| Provider Name | Andrea Young Willer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790126399 PECOS PAC ID: 5597992578 Enrollment ID: I20131219000516 |
| Provider Name | Nathan Lee Granneman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1689960171 PECOS PAC ID: 9436384542 Enrollment ID: I20140306000407 |
| Provider Name | Melinda Carol Hart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619399003 PECOS PAC ID: 5698905842 Enrollment ID: I20140307001528 |
| Provider Name | Reggie A Vaden |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1700983343 PECOS PAC ID: 5294622536 Enrollment ID: I20140425001393 |
| Provider Name | Tareq M Abu Salah |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1417914474 PECOS PAC ID: 0042476251 Enrollment ID: I20140513000399 |
| Provider Name | Matthew K. Bokermann |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740441963 PECOS PAC ID: 0042433880 Enrollment ID: I20140522001752 |
| Provider Name | Ryan A Strain |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1538397690 PECOS PAC ID: 4880819960 Enrollment ID: I20140703000526 |
| Provider Name | Erica H Salinas |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1396914321 PECOS PAC ID: 7214161116 Enrollment ID: I20140911001889 |
| Provider Name | Delali K Buatsi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1275778649 PECOS PAC ID: 4082872346 Enrollment ID: I20141008000790 |
| Provider Name | Karen L Florio |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1932405776 PECOS PAC ID: 9032397278 Enrollment ID: I20141021002542 |
| Provider Name | Abby Marie Brunnert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679989800 PECOS PAC ID: 0446573232 Enrollment ID: I20141231001682 |
| Provider Name | Shelton C Blevins |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1376951590 PECOS PAC ID: 9335466978 Enrollment ID: I20150319002352 |
| Provider Name | Ashley Moore |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477868990 PECOS PAC ID: 3678767035 Enrollment ID: I20150701002481 |
| Provider Name | Wendell Nall |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1447306725 PECOS PAC ID: 6002128105 Enrollment ID: I20150702000172 |
| Provider Name | Kate L Grossman |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1841452869 PECOS PAC ID: 7416127337 Enrollment ID: I20150702000201 |
| Provider Name | Joshua B Mongler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841551660 PECOS PAC ID: 1557595725 Enrollment ID: I20150710001502 |
| Provider Name | Benjamin Kuster |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1376923730 PECOS PAC ID: 5193038230 Enrollment ID: I20150720001263 |
| Provider Name | Angela Yuen |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1578819140 PECOS PAC ID: 6709199375 Enrollment ID: I20150727000148 |
| Provider Name | Aruna Cheddi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1053676197 PECOS PAC ID: 9133437833 Enrollment ID: I20150930000105 |
| Provider Name | Brittany A Kammerich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396157699 PECOS PAC ID: 7719295344 Enrollment ID: I20151001001635 |
| Provider Name | Lauren Nicole Obrien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790153922 PECOS PAC ID: 7810297264 Enrollment ID: I20151208000609 |
| Provider Name | Jonathan Daniel Barnes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376915678 PECOS PAC ID: 4880995265 Enrollment ID: I20151209002463 |
| Provider Name | Kristi Schroeder |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1205842937 PECOS PAC ID: 7517187107 Enrollment ID: I20151210002696 |
| Provider Name | Garrel L Renick |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1114288495 PECOS PAC ID: 6406156454 Enrollment ID: I20160304001495 |
| Provider Name | Logan Anthony Frank |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356655104 PECOS PAC ID: 1557595204 Enrollment ID: I20160607002199 |
| Provider Name | Jeffrey W Boss |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053576827 PECOS PAC ID: 9133363344 Enrollment ID: I20160608000258 |
| Provider Name | Ursula Reusch |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477633063 PECOS PAC ID: 4082614755 Enrollment ID: I20160712000627 |
| Provider Name | Ryan B Siebert |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780968198 PECOS PAC ID: 8820380629 Enrollment ID: I20160719002461 |
| Provider Name | Chad P Zeglis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053751578 PECOS PAC ID: 4688808710 Enrollment ID: I20160729000486 |
| Provider Name | Steveny Grieve |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659735595 PECOS PAC ID: 4688968837 Enrollment ID: I20160810001742 |
| Provider Name | Elizabeth M Fagiolo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689038101 PECOS PAC ID: 8729373220 Enrollment ID: I20160823001912 |
| Provider Name | Mario Alejandro Tapia Gomez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851563787 PECOS PAC ID: 2668542374 Enrollment ID: I20160926000060 |
| Provider Name | Ashley Paige Makowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740631928 PECOS PAC ID: 5698054021 Enrollment ID: I20161108000641 |
| Provider Name | Stephanie M Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255734836 PECOS PAC ID: 0840514279 Enrollment ID: I20161117001008 |
| Provider Name | Farzin Fotouhi |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1679562920 PECOS PAC ID: 4385669076 Enrollment ID: I20170126002378 |
| Provider Name | Mindy Lou Doscher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003274440 PECOS PAC ID: 8224312657 Enrollment ID: I20170303000911 |
| Provider Name | Pierre E Laughton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578523999 PECOS PAC ID: 2860579778 Enrollment ID: I20170306000491 |
| Provider Name | Matthew T Mcleay |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1265434328 PECOS PAC ID: 7618969783 Enrollment ID: I20170403002017 |
| Provider Name | Rubin Jit Singh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942615992 PECOS PAC ID: 9537466115 Enrollment ID: I20170724002911 |
| Provider Name | Timur Gusov |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1144633868 PECOS PAC ID: 7911272604 Enrollment ID: I20171005001775 |
| Provider Name | Beth Fisher |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1720280134 PECOS PAC ID: 9032279393 Enrollment ID: I20180305000125 |
| Provider Name | Patricia E Watson-adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578006714 PECOS PAC ID: 5092077198 Enrollment ID: I20180402000295 |
| Provider Name | Andres Bran Acevedo |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1821353509 PECOS PAC ID: 1658643267 Enrollment ID: I20180711001383 |
| Provider Name | Jane Isabelle Foreman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699267047 PECOS PAC ID: 8820346109 Enrollment ID: I20180802000952 |
| Provider Name | John A Fernando |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487049250 PECOS PAC ID: 2567764723 Enrollment ID: I20180815001968 |
| Provider Name | Farhan Siddiq |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1740472745 PECOS PAC ID: 7214006618 Enrollment ID: I20180816001052 |
| Provider Name | Jason Douglas Blanchard |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1457747271 PECOS PAC ID: 7719263128 Enrollment ID: I20180904002027 |
| Provider Name | Steven Benjamin Carr |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1588989172 PECOS PAC ID: 4981954377 Enrollment ID: I20180905003292 |
| Provider Name | Stephanie Whitbey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043796444 PECOS PAC ID: 5395096077 Enrollment ID: I20180919001033 |
| Provider Name | Florence I Adimora-nweke |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1184042038 PECOS PAC ID: 7214201797 Enrollment ID: I20180926001477 |
| Provider Name | Jamie D Markway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821588609 PECOS PAC ID: 5496007759 Enrollment ID: I20181015002262 |
| Provider Name | Rebecca Cates Shetley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1689146060 PECOS PAC ID: 8729325816 Enrollment ID: I20190128002355 |
| Provider Name | Ndeye Marieme Ndiaye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972076743 PECOS PAC ID: 2668712472 Enrollment ID: I20190314000080 |
| Provider Name | Ahmad Abou Leila |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1861741126 PECOS PAC ID: 4183993546 Enrollment ID: I20190417000333 |
| Provider Name | Cody M Eckelkamp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154988327 PECOS PAC ID: 4789919150 Enrollment ID: I20190709000476 |
| Provider Name | Taylor B Nelson |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1104230903 PECOS PAC ID: 6002032430 Enrollment ID: I20190710002536 |
| Provider Name | Crystelle Wiona Canuto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063076313 PECOS PAC ID: 9234465683 Enrollment ID: I20190724000138 |
| Provider Name | Muhammad F. Asghar |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1063862795 PECOS PAC ID: 3870860547 Enrollment ID: I20190729001313 |
| Provider Name | Ghulam Ghous |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003260787 PECOS PAC ID: 7810223641 Enrollment ID: I20190731001734 |
| Provider Name | Mustafa A Alsaid Alkhreisat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205268588 PECOS PAC ID: 3678869153 Enrollment ID: I20190802002010 |
| Provider Name | Daniel W Lovinger |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1598115693 PECOS PAC ID: 8123310091 Enrollment ID: I20190805000851 |
| Provider Name | Blake J Welschmeyer |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1154771178 PECOS PAC ID: 8224320106 Enrollment ID: I20190808003775 |
| Provider Name | Laneshia K Tague |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1619276136 PECOS PAC ID: 1355561762 Enrollment ID: I20190920001282 |
| Provider Name | Shambhu Bhagat |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1972954097 PECOS PAC ID: 1850645607 Enrollment ID: I20190924000407 |
| Provider Name | Christopher P Schiavo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1700268133 PECOS PAC ID: 4981916301 Enrollment ID: I20191022003498 |
| Provider Name | Rebekah C Bail |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023664562 PECOS PAC ID: 3678805785 Enrollment ID: I20191022003571 |
| Provider Name | Sarah Rene Mcbee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235790833 PECOS PAC ID: 8426481805 Enrollment ID: I20191126001906 |
| Provider Name | Allison R Arends |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336780105 PECOS PAC ID: 5395170997 Enrollment ID: I20200108001313 |
| Provider Name | Kellie Marie Asher |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598395691 PECOS PAC ID: 5597191395 Enrollment ID: I20200213001760 |
| Provider Name | Robin Elizabeth Howard-boyd |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003435454 PECOS PAC ID: 2668802364 Enrollment ID: I20200421000877 |
| Provider Name | Phillip P Beck |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1700236882 PECOS PAC ID: 4981996857 Enrollment ID: I20200423003087 |
| Provider Name | Charlotte Lin Chang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578083515 PECOS PAC ID: 7618248568 Enrollment ID: I20200515001945 |
| Provider Name | Rachael N Brashears |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1427445493 PECOS PAC ID: 2668776303 Enrollment ID: I20200710002862 |
| Provider Name | Felix Nau Jr |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1932632544 PECOS PAC ID: 5294005351 Enrollment ID: I20200721001367 |
| Provider Name | Matthew C Bean |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881089951 PECOS PAC ID: 9830402619 Enrollment ID: I20200729003241 |
| Provider Name | Yuan Yuan Xie |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083018428 PECOS PAC ID: 9537496252 Enrollment ID: I20200803002177 |
| Provider Name | Evan G Mason |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699195701 PECOS PAC ID: 5991092884 Enrollment ID: I20200812000819 |
| Provider Name | Saqib Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376978064 PECOS PAC ID: 5294964250 Enrollment ID: I20200813002891 |
| Provider Name | Anne Cahill |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1326066036 PECOS PAC ID: 5092711465 Enrollment ID: I20200824001829 |
| Provider Name | Bethany R Mullinix |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336671023 PECOS PAC ID: 0648538694 Enrollment ID: I20200827002789 |
| Provider Name | Arooj Mohsin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821521386 PECOS PAC ID: 8527331297 Enrollment ID: I20201012000656 |
| Provider Name | Elizabeth Anne Snodgrass-stringer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588207310 PECOS PAC ID: 5395178149 Enrollment ID: I20201015003367 |
| Provider Name | Katelyn Foley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1366043630 PECOS PAC ID: 1850702952 Enrollment ID: I20201120002054 |
| Provider Name | Pamela Louise Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841806551 PECOS PAC ID: 8022423698 Enrollment ID: I20210211001701 |
| Provider Name | Kari Angela Jansing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124621289 PECOS PAC ID: 6406261726 Enrollment ID: I20210219000401 |
| Provider Name | Lindsey Michelle Redington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861095580 PECOS PAC ID: 6204241417 Enrollment ID: I20210222001987 |
| Provider Name | Lauren Wood Breshears |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861887689 PECOS PAC ID: 0446667893 Enrollment ID: I20210331000675 |
| Provider Name | Mary Christie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477147775 PECOS PAC ID: 2860800539 Enrollment ID: I20210419000169 |
| Provider Name | Hunter Douglas Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811580566 PECOS PAC ID: 4981013026 Enrollment ID: I20210503000602 |
| Provider Name | Sarah Larraine Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912571282 PECOS PAC ID: 5395145205 Enrollment ID: I20210615001669 |
| Provider Name | Syed Osama Hassan |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1245728492 PECOS PAC ID: 4981005477 Enrollment ID: I20210622000202 |
| Provider Name | Brandi Dawn Zey-thacker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679170047 PECOS PAC ID: 9032511183 Enrollment ID: I20210712002511 |
| Provider Name | Khadrah M Alsomali |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689019598 PECOS PAC ID: 6608095930 Enrollment ID: I20210713002812 |
| Provider Name | Joy Annette Wolfe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306345368 PECOS PAC ID: 8820491194 Enrollment ID: I20210723001360 |
| Provider Name | Elyssa Ann Gibbons |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1447923313 PECOS PAC ID: 3577967306 Enrollment ID: I20210802001200 |
| Provider Name | Liza Suzanne Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386217388 PECOS PAC ID: 4880091990 Enrollment ID: I20210916000114 |
| Provider Name | Matthew Bryant Maasen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1265006662 PECOS PAC ID: 8527465657 Enrollment ID: I20210916000925 |
| Provider Name | Leah Nicole Leicht |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1225539547 PECOS PAC ID: 5597162131 Enrollment ID: I20210923001840 |
| Provider Name | Grace Elizabeth Wilson |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1750761532 PECOS PAC ID: 0244542660 Enrollment ID: I20210929003020 |
| Provider Name | Kearsta Ornellas |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144985888 PECOS PAC ID: 1850780842 Enrollment ID: I20211112001273 |
| Provider Name | Ashley Renee Walker-ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104385335 PECOS PAC ID: 3173851466 Enrollment ID: I20211115002281 |
| Provider Name | Jean Ricci Goodman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1447228093 PECOS PAC ID: 4385675669 Enrollment ID: I20211122001654 |
| Provider Name | Emma L Mallory |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013672104 PECOS PAC ID: 9133519572 Enrollment ID: I20211129002282 |
| Provider Name | Julia Cosma |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194711515 PECOS PAC ID: 0749207991 Enrollment ID: I20211202000944 |
| Provider Name | Khalid Sabha |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902911068 PECOS PAC ID: 2668575325 Enrollment ID: I20211202001523 |
| Provider Name | Andrea Feger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518530385 PECOS PAC ID: 9133519226 Enrollment ID: I20211203001578 |
| Provider Name | Brogan Tipton |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1225552664 PECOS PAC ID: 0244563450 Enrollment ID: I20211206001012 |
| Provider Name | Lance Joseph Leverenz |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1457010647 PECOS PAC ID: 3476944059 Enrollment ID: I20211216000681 |
| Provider Name | Tammy L Doerhoff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518628163 PECOS PAC ID: 9830582444 Enrollment ID: I20220203000224 |
| Provider Name | Daniel J Cranford |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497068795 PECOS PAC ID: 8123349297 Enrollment ID: I20220209001309 |
| Provider Name | Michael James Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174271803 PECOS PAC ID: 2163819046 Enrollment ID: I20220422001603 |
| Provider Name | Ashley C Altman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649697947 PECOS PAC ID: 3072835941 Enrollment ID: I20220505001738 |
| Provider Name | James Bryce Boudreau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689312787 PECOS PAC ID: 9739561812 Enrollment ID: I20220805002064 |
| Provider Name | Mary R.a Mikhael |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1285286674 PECOS PAC ID: 7315277514 Enrollment ID: I20220809000271 |
| Provider Name | Kevin M Rice |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467418327 PECOS PAC ID: 7517850258 Enrollment ID: I20220812002104 |
| Provider Name | Ronald L Jones |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063919538 PECOS PAC ID: 3779838495 Enrollment ID: I20220818000712 |
| Provider Name | Joseph W Mcgreevy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447716683 PECOS PAC ID: 2365770567 Enrollment ID: I20220823001215 |
| Provider Name | Sarah Elizabeth Severance |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1609256981 PECOS PAC ID: 0244551927 Enrollment ID: I20220908001717 |
| Provider Name | Daniel Elizondo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366002362 PECOS PAC ID: 1456687672 Enrollment ID: I20220913000682 |
| Provider Name | Meagan Michelle Fansler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720715485 PECOS PAC ID: 0345625125 Enrollment ID: I20220914002426 |
| Provider Name | Brian Edward Gonzales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295453397 PECOS PAC ID: 8325423106 Enrollment ID: I20220914002526 |
| Provider Name | Benjamin Gerber |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1467748673 PECOS PAC ID: 6800038555 Enrollment ID: I20220919003031 |
| Provider Name | Jonathan M Rindner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275064651 PECOS PAC ID: 3072885052 Enrollment ID: I20220921000991 |
| Provider Name | Peter James Nilsson |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1104347046 PECOS PAC ID: 4284904665 Enrollment ID: I20220923002664 |
| Provider Name | Frederic C. Park |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1821189002 PECOS PAC ID: 1355339326 Enrollment ID: I20220928001132 |
| Provider Name | Dante Dali |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1124468517 PECOS PAC ID: 9133362585 Enrollment ID: I20221014002447 |
| Provider Name | Julie M Lane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881311009 PECOS PAC ID: 3678942604 Enrollment ID: I20221213002166 |
| Provider Name | Briana Kathleen Kile |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447961511 PECOS PAC ID: 8123497088 Enrollment ID: I20221215001792 |
| Provider Name | Michael W Ciaschini |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558490805 PECOS PAC ID: 1850490517 Enrollment ID: I20230105001912 |
| Provider Name | Antoinette M Metzner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295447886 PECOS PAC ID: 5294105029 Enrollment ID: I20230111003037 |
| Provider Name | Karen B Willens |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043389935 PECOS PAC ID: 2466469671 Enrollment ID: I20230301002476 |
| Provider Name | Matthew P Hesh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386755833 PECOS PAC ID: 5890794663 Enrollment ID: I20230302003090 |
| Provider Name | Christopher Michael Benne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487353942 PECOS PAC ID: 0648644518 Enrollment ID: I20230315001973 |
| Provider Name | Chukwudi Eke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801066733 PECOS PAC ID: 7012078553 Enrollment ID: I20230322002070 |
| Provider Name | Robert I Lieberman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841428364 PECOS PAC ID: 2062689425 Enrollment ID: I20230327001368 |
| Provider Name | John C Clarke |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659575744 PECOS PAC ID: 7416916358 Enrollment ID: I20230518000432 |
| Provider Name | Frederick E Butt |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114410412 PECOS PAC ID: 3678820404 Enrollment ID: I20230621000667 |
| Provider Name | Sadiat Adebiyi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811627672 PECOS PAC ID: 8426423591 Enrollment ID: I20230621002986 |
| Provider Name | Brandi J Haerer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467144931 PECOS PAC ID: 7012376684 Enrollment ID: I20230630000155 |
| Provider Name | Conor Williams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952927667 PECOS PAC ID: 7416375431 Enrollment ID: I20230801000899 |
| Provider Name | John D Richard |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1568448116 PECOS PAC ID: 9830550045 Enrollment ID: I20230804000443 |
| Provider Name | Noel Lucas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184676090 PECOS PAC ID: 1759317316 Enrollment ID: I20230912002740 |
| Provider Name | Natalie Ann Bethel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447843263 PECOS PAC ID: 5698129732 Enrollment ID: I20230923000561 |
| Provider Name | Gustavo A Avila Amat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437655131 PECOS PAC ID: 8628305182 Enrollment ID: I20231005002802 |
| Provider Name | Holly Doogs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487433074 PECOS PAC ID: 4981997699 Enrollment ID: I20231011000581 |
| Provider Name | Thomas R Drake |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1427087816 PECOS PAC ID: 3173604170 Enrollment ID: I20231013000917 |
| Provider Name | Daniel Lyon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821614272 PECOS PAC ID: 2769805829 Enrollment ID: I20231215001330 |
| Provider Name | Balint Istvan Otvos |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1720338452 PECOS PAC ID: 6305148644 Enrollment ID: I20240108005217 |
| Provider Name | Brooke Zukowski |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1720856487 PECOS PAC ID: 3476905571 Enrollment ID: I20240113000203 |
| Provider Name | Noah Brayden Cunningham |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1053194217 PECOS PAC ID: 1658724281 Enrollment ID: I20240130002286 |
| Provider Name | Raymond Churk-yin Lee |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1134422934 PECOS PAC ID: 4981851292 Enrollment ID: I20240401000206 |
| Provider Name | Brandon Michael Wiler |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1932643160 PECOS PAC ID: 6507205226 Enrollment ID: I20240415001877 |
Columbia Family Medical Group, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 303 N Keene St, Suite 301, Columbia, MO 65201 Phone: 573-449-0808 Fax: 573-442-1331 | |
Sme Virginia Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5728 Pergola Dr Apt 207, Columbia, MO 65201 Phone: 678-977-5507 | |
University Physicians Specialty Care Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3100 W Broadway, Columbia, MO 65203 Phone: 573-884-7701 | |
Sme Utah, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5728 Pergola Dr Apt 207, Columbia, MO 65201 Phone: 678-977-5507 | |
Sme Idaho P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5728 Pergola Dr Apt 207, Columbia, MO 65201 Phone: 678-977-5507 | |
Nephrology And Hypertension Associates Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1205 W Broadway, Columbia, MO 65203 Phone: 573-499-0642 Fax: 573-449-1787 | |
Family Dental Center Columbia East Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2475 Broadway Bluffs Dr, Suite 200, Columbia, MO 65201 Phone: 573-777-9282 Fax: 573-777-9569 |