| Chickasaw Nation Medical Center | |
|
1921 Stonecipher Boulevard Ada OK 74820-3439 | |
| (580) 421-4570 | |
| (580) 421-6283 |
| Full Name | Chickasaw Nation Medical Center |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 1921 Stonecipher Boulevard, Ada, Oklahoma |
| Authorized Official Name and Position | Denise Carpenter (CONTRACT MANAGEMENT COORDINATOR) |
| Authorized Official Contact | 4054214570 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chickasaw Nation Medical Center 1925 Warrior Way Ada OK 74820 Ph: (580) 421-4570 | Chickasaw Nation Medical Center 1921 Stonecipher Boulevard Ada OK 74820-3439 Ph: (580) 421-4570 |
| NPI Number | 1255364923 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 06/12/2024 |
| Medicare PECOS PAC ID | 8426957523 |
|---|---|
| Medicare Enrollment ID | O20040108000364 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255364923 | NPI | - | NPPES |
| Provider Name | Laura L Hill |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1427021864 PECOS PAC ID: 1557266822 Enrollment ID: I20040107000861 |
| Provider Name | Tracy L Thompson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639162704 PECOS PAC ID: 6305736604 Enrollment ID: I20040318001824 |
| Provider Name | Dong Zhao |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619942752 PECOS PAC ID: 4183515372 Enrollment ID: I20040324001686 |
| Provider Name | Richard B Mcclain |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1073590857 PECOS PAC ID: 5698688760 Enrollment ID: I20040506001166 |
| Provider Name | John T Krueger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285600262 PECOS PAC ID: 6002806783 Enrollment ID: I20040514000528 |
| Provider Name | Wayne H Harris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184672578 PECOS PAC ID: 3274515598 Enrollment ID: I20040607001101 |
| Provider Name | Brian Joachims |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619954682 PECOS PAC ID: 6901868157 Enrollment ID: I20041029000715 |
| Provider Name | Shannon Patrick Calhoun |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1598715278 PECOS PAC ID: 7911804398 Enrollment ID: I20050826000631 |
| Provider Name | Serena E Black Sheppard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609855410 PECOS PAC ID: 1951326248 Enrollment ID: I20051005001080 |
| Provider Name | Edward Fogarty |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902826340 PECOS PAC ID: 7012814643 Enrollment ID: I20051208000611 |
| Provider Name | Humberto G Quintero |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821074691 PECOS PAC ID: 4082636642 Enrollment ID: I20051222000535 |
| Provider Name | Tina Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902882749 PECOS PAC ID: 1658394952 Enrollment ID: I20060112000877 |
| Provider Name | Melissa G Vavricka Conaway |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1992839211 PECOS PAC ID: 7618075839 Enrollment ID: I20070611000649 |
| Provider Name | Daniel Molina |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902001258 PECOS PAC ID: 1052402005 Enrollment ID: I20070806000855 |
| Provider Name | Derek Howard |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790880219 PECOS PAC ID: 2668488057 Enrollment ID: I20070925000273 |
| Provider Name | Steven Hill |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1265405278 PECOS PAC ID: 4284720566 Enrollment ID: I20071017000925 |
| Provider Name | Abdul N Khan |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1215919881 PECOS PAC ID: 9739080375 Enrollment ID: I20080604000733 |
| Provider Name | Heather M Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881850477 PECOS PAC ID: 5597823674 Enrollment ID: I20081017000426 |
| Provider Name | Karina M Jandziszak |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841282399 PECOS PAC ID: 8729147558 Enrollment ID: I20081107000276 |
| Provider Name | Eugene Park Chung |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528030525 PECOS PAC ID: 4486624160 Enrollment ID: I20081124000142 |
| Provider Name | Cecily B Floyd |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1073706313 PECOS PAC ID: 4981691896 Enrollment ID: I20081201000406 |
| Provider Name | Judith Wolfstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013914456 PECOS PAC ID: 0345135232 Enrollment ID: I20081203000298 |
| Provider Name | Veronica Yumo Ruvo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740252725 PECOS PAC ID: 4183523855 Enrollment ID: I20081203000436 |
| Provider Name | Waheed Jalalzai |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669444246 PECOS PAC ID: 6305816513 Enrollment ID: I20081204000076 |
| Provider Name | Douglas C Nolan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700893898 PECOS PAC ID: 6709949381 Enrollment ID: I20090107000656 |
| Provider Name | Roger J Charboneau |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1609862689 PECOS PAC ID: 6204891609 Enrollment ID: I20090109000197 |
| Provider Name | Rikki J Scoggin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154434157 PECOS PAC ID: 3971669888 Enrollment ID: I20090302000238 |
| Provider Name | Virginia L Austin |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1245476936 PECOS PAC ID: 1951458579 Enrollment ID: I20090416000197 |
| Provider Name | Shazli P Naseer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912928987 PECOS PAC ID: 9931100591 Enrollment ID: I20090707000484 |
| Provider Name | Jonathan Jaksha |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871555649 PECOS PAC ID: 3274632054 Enrollment ID: I20090904000224 |
| Provider Name | Larry Sharp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306903315 PECOS PAC ID: 3476694217 Enrollment ID: I20091230000628 |
| Provider Name | Todd K Pogue |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083659635 PECOS PAC ID: 5890684393 Enrollment ID: I20100419000812 |
| Provider Name | Lisa Rhynes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649259458 PECOS PAC ID: 9234266206 Enrollment ID: I20100422000782 |
| Provider Name | Mitchell R Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346227113 PECOS PAC ID: 7315983004 Enrollment ID: I20100521000456 |
| Provider Name | Susan Hurst |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1326025859 PECOS PAC ID: 2668501107 Enrollment ID: I20100521000566 |
| Provider Name | Randi D Skender |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821235730 PECOS PAC ID: 3274662655 Enrollment ID: I20100524000105 |
| Provider Name | Jerry A Gregory |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1467400069 PECOS PAC ID: 0648309914 Enrollment ID: I20100525000340 |
| Provider Name | Jonathan G Reed |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588653075 PECOS PAC ID: 3577669928 Enrollment ID: I20100719000914 |
| Provider Name | Carol Rhoads |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1528050291 PECOS PAC ID: 4082689559 Enrollment ID: I20100914001319 |
| Provider Name | Jennifer L James |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1508184847 PECOS PAC ID: 4284750266 Enrollment ID: I20100928000088 |
| Provider Name | Julie K Wolfe |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1114937117 PECOS PAC ID: 0648362525 Enrollment ID: I20101102000959 |
| Provider Name | Christie Snow |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205054491 PECOS PAC ID: 6901091149 Enrollment ID: I20101112000593 |
| Provider Name | Daniel Woods |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1902879356 PECOS PAC ID: 4284821190 Enrollment ID: I20101203001087 |
| Provider Name | Ronald M Pence |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427276609 PECOS PAC ID: 9133316649 Enrollment ID: I20101209001011 |
| Provider Name | Charles Whiting |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194702696 PECOS PAC ID: 9830194265 Enrollment ID: I20110107000522 |
| Provider Name | Judy Goforth-parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952604829 PECOS PAC ID: 0345381158 Enrollment ID: I20110111000958 |
| Provider Name | Baolong Nguyen |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1710962071 PECOS PAC ID: 5799769873 Enrollment ID: I20110317000907 |
| Provider Name | Martel G Samuels |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760793566 PECOS PAC ID: 3870779242 Enrollment ID: I20110519000338 |
| Provider Name | Kelly D Reid |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982995791 PECOS PAC ID: 9537346408 Enrollment ID: I20110601000255 |
| Provider Name | John P Dickinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790098150 PECOS PAC ID: 0446430532 Enrollment ID: I20110823001052 |
| Provider Name | Brian Gaddis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366750069 PECOS PAC ID: 0345411930 Enrollment ID: I20110910002889 |
| Provider Name | Megan Slate |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1306125968 PECOS PAC ID: 9537333125 Enrollment ID: I20111116000616 |
| Provider Name | Justin Roulston |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407144728 PECOS PAC ID: 4688840291 Enrollment ID: I20120103000733 |
| Provider Name | Connie M Wilson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235192881 PECOS PAC ID: 1759470354 Enrollment ID: I20120306001024 |
| Provider Name | Vinay A Shah |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1013951409 PECOS PAC ID: 2567513492 Enrollment ID: I20120313000984 |
| Provider Name | Steven L Fillmore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225010655 PECOS PAC ID: 2668403080 Enrollment ID: I20120615000567 |
| Provider Name | Paula A Deupree |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407901085 PECOS PAC ID: 2860678562 Enrollment ID: I20120921000351 |
| Provider Name | Kayla D Dewitt |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831446145 PECOS PAC ID: 3971752585 Enrollment ID: I20120925000507 |
| Provider Name | Robert M Clark |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174528525 PECOS PAC ID: 7113988841 Enrollment ID: I20121107000672 |
| Provider Name | George S Chrysant |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1093719015 PECOS PAC ID: 8729049077 Enrollment ID: I20121107000687 |
| Provider Name | Jeffrey M Sparling |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1679535223 PECOS PAC ID: 6103808043 Enrollment ID: I20130123000024 |
| Provider Name | Lewis A Wallace |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942292271 PECOS PAC ID: 8921100322 Enrollment ID: I20130208000391 |
| Provider Name | Billy Joe Boyd |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063405769 PECOS PAC ID: 2365464872 Enrollment ID: I20130214000113 |
| Provider Name | Misty Boyd |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568455764 PECOS PAC ID: 8729000344 Enrollment ID: I20130220000371 |
| Provider Name | Kevin Langley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851644413 PECOS PAC ID: 4385897883 Enrollment ID: I20130409000382 |
| Provider Name | Karen G Phillips |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801992813 PECOS PAC ID: 8729024161 Enrollment ID: I20130726000670 |
| Provider Name | Cynthia L Nydick |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1992714901 PECOS PAC ID: 6901800135 Enrollment ID: I20130730000296 |
| Provider Name | Kalen J Rogers |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1225265796 PECOS PAC ID: 1759524200 Enrollment ID: I20130830000586 |
| Provider Name | Shirley J Welden |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114123619 PECOS PAC ID: 4688731359 Enrollment ID: I20131018000701 |
| Provider Name | John W Mooring |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1174734495 PECOS PAC ID: 9830330216 Enrollment ID: I20131030000671 |
| Provider Name | Rebecca Linn Schaub |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609042209 PECOS PAC ID: 7214164748 Enrollment ID: I20131209000387 |
| Provider Name | Tracy L Langley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619085941 PECOS PAC ID: 4688673866 Enrollment ID: I20131218000079 |
| Provider Name | George A Vascellaro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285606608 PECOS PAC ID: 4688652225 Enrollment ID: I20140128001121 |
| Provider Name | Crystalle M Evans |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043560030 PECOS PAC ID: 5395997639 Enrollment ID: I20140131001174 |
| Provider Name | Travis Thompson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1114205994 PECOS PAC ID: 6901035559 Enrollment ID: I20140131001380 |
| Provider Name | Jon Humphers |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1619284155 PECOS PAC ID: 1456581883 Enrollment ID: I20140305001049 |
| Provider Name | Laura Brewer James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972881175 PECOS PAC ID: 5193983427 Enrollment ID: I20140307000651 |
| Provider Name | Anne M Lewis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750553491 PECOS PAC ID: 6406092139 Enrollment ID: I20140614000084 |
| Provider Name | Kevin W Maddox |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1598082398 PECOS PAC ID: 6002033735 Enrollment ID: I20140804001506 |
| Provider Name | Jason Grennan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457313314 PECOS PAC ID: 9830179092 Enrollment ID: I20140812001681 |
| Provider Name | Randy A Rogers |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1063528743 PECOS PAC ID: 5193719094 Enrollment ID: I20141002001229 |
| Provider Name | Phillip T Fuller |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1871720300 PECOS PAC ID: 9335373802 Enrollment ID: I20141201001941 |
| Provider Name | Christopher M Poarch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871850628 PECOS PAC ID: 3173773215 Enrollment ID: I20150112000427 |
| Provider Name | Jeff M Hood |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1861481954 PECOS PAC ID: 1951450428 Enrollment ID: I20150126000808 |
| Provider Name | Ladny J Yates |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1679562243 PECOS PAC ID: 4981764677 Enrollment ID: I20150130000546 |
| Provider Name | Cassie R Sawatzky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083016026 PECOS PAC ID: 3577889112 Enrollment ID: I20150226000487 |
| Provider Name | Joshua C Medved |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104266659 PECOS PAC ID: 0648408971 Enrollment ID: I20150527002215 |
| Provider Name | Lisa Frank |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447212881 PECOS PAC ID: 9830129907 Enrollment ID: I20150915000192 |
| Provider Name | Tangra Broge |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1851689517 PECOS PAC ID: 6204146020 Enrollment ID: I20151106001973 |
| Provider Name | Melissa K Colbert |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093000184 PECOS PAC ID: 4587964234 Enrollment ID: I20151202000099 |
| Provider Name | Kiet T Le |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528325537 PECOS PAC ID: 6507174877 Enrollment ID: I20151204001216 |
| Provider Name | Robin Losee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083056642 PECOS PAC ID: 4385947951 Enrollment ID: I20160115000114 |
| Provider Name | Whitney Tolpinrud |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1932493053 PECOS PAC ID: 0244541548 Enrollment ID: I20160303002517 |
| Provider Name | Anthony Rowe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518120575 PECOS PAC ID: 8921246273 Enrollment ID: I20160328000659 |
| Provider Name | David H Chansolme |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1457343402 PECOS PAC ID: 1557331782 Enrollment ID: I20160523001971 |
| Provider Name | Andrea Scott |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1346406899 PECOS PAC ID: 1557530862 Enrollment ID: I20160620000638 |
| Provider Name | Rina A Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871770065 PECOS PAC ID: 1759674377 Enrollment ID: I20160720000212 |
| Provider Name | Tammy Holder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730530932 PECOS PAC ID: 7113213562 Enrollment ID: I20160910000229 |
| Provider Name | Benjamin E Martin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346647849 PECOS PAC ID: 9234426875 Enrollment ID: I20160924000057 |
| Provider Name | Jeffrey Munholland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669716353 PECOS PAC ID: 4880838374 Enrollment ID: I20161025000491 |
| Provider Name | Michelle Marie Baxter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912348970 PECOS PAC ID: 1355631623 Enrollment ID: I20170111000234 |
| Provider Name | Katie Burden Greer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487948915 PECOS PAC ID: 3577790120 Enrollment ID: I20170125001221 |
| Provider Name | Frank Joseph Welte |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568676948 PECOS PAC ID: 6800933847 Enrollment ID: I20170712000802 |
| Provider Name | Debra Degering |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235582099 PECOS PAC ID: 5193012268 Enrollment ID: I20170830000988 |
| Provider Name | Andres Rodrigo Caero Romero |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902193865 PECOS PAC ID: 8022313253 Enrollment ID: I20171108001930 |
| Provider Name | Sean C Ludlow |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1780789388 PECOS PAC ID: 2466452081 Enrollment ID: I20171213000823 |
| Provider Name | Nicole Mcelroy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295108751 PECOS PAC ID: 4981905312 Enrollment ID: I20171218000462 |
| Provider Name | Glen Edward Diacon |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1588659957 PECOS PAC ID: 8224189410 Enrollment ID: I20171227001888 |
| Provider Name | Theodore Mark Rutledge |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508942285 PECOS PAC ID: 9335242825 Enrollment ID: I20180109001727 |
| Provider Name | Jeffrey Wells |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588017131 PECOS PAC ID: 7012278211 Enrollment ID: I20180305001100 |
| Provider Name | Jeffrey Thomas Mcphail |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1245274307 PECOS PAC ID: 1052316403 Enrollment ID: I20180313001087 |
| Provider Name | Dana Kay Jarrett |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1487875902 PECOS PAC ID: 0547522864 Enrollment ID: I20180327001669 |
| Provider Name | Daniel J Allman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063847952 PECOS PAC ID: 9133481351 Enrollment ID: I20180327001934 |
| Provider Name | Heather James |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1285137281 PECOS PAC ID: 8426310426 Enrollment ID: I20180402000448 |
| Provider Name | Glenn Berry |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1376878108 PECOS PAC ID: 4082976030 Enrollment ID: I20180403000548 |
| Provider Name | Mohammed Quraishi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871545269 PECOS PAC ID: 8123030814 Enrollment ID: I20180404002328 |
| Provider Name | Chance Nolan Cruson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982998225 PECOS PAC ID: 0143539064 Enrollment ID: I20180406000878 |
| Provider Name | Lindsy Wells |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1104377522 PECOS PAC ID: 5395008189 Enrollment ID: I20180409001279 |
| Provider Name | Olivia Danielle Reed |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013380021 PECOS PAC ID: 0749543494 Enrollment ID: I20180411002718 |
| Provider Name | Timothy R Brown |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1073947768 PECOS PAC ID: 4981839438 Enrollment ID: I20180419000730 |
| Provider Name | Jennifer James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528448032 PECOS PAC ID: 8022329028 Enrollment ID: I20180508000733 |
| Provider Name | Amanda Newberry |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1558615567 PECOS PAC ID: 1456616374 Enrollment ID: I20180524001562 |
| Provider Name | Jaime Smith |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1851708838 PECOS PAC ID: 5395035216 Enrollment ID: I20180613000817 |
| Provider Name | Marilyn Lynne Hines |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942217336 PECOS PAC ID: 6608760277 Enrollment ID: I20180618000637 |
| Provider Name | Christina M Vega |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1942453360 PECOS PAC ID: 9830250505 Enrollment ID: I20180703001444 |
| Provider Name | Candis Clark |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1235623570 PECOS PAC ID: 3971859653 Enrollment ID: I20180711001016 |
| Provider Name | Stanley R Smith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003802968 PECOS PAC ID: 4082527205 Enrollment ID: I20180802000503 |
| Provider Name | Danielle Burkdoll |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1063706679 PECOS PAC ID: 3779879606 Enrollment ID: I20180810001359 |
| Provider Name | Kimberly Michelle Roark |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1992965602 PECOS PAC ID: 5395901870 Enrollment ID: I20180810002538 |
| Provider Name | Allison Summers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316926272 PECOS PAC ID: 1052366267 Enrollment ID: I20180820001492 |
| Provider Name | Adam Carter |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1124507686 PECOS PAC ID: 4284984600 Enrollment ID: I20180906000490 |
| Provider Name | Beth M. May |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497743611 PECOS PAC ID: 2860449444 Enrollment ID: I20180913002074 |
| Provider Name | Steven Todd Mccormack |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023000338 PECOS PAC ID: 4183651987 Enrollment ID: I20180914000083 |
| Provider Name | Yolette Louis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225316318 PECOS PAC ID: 6204070790 Enrollment ID: I20181029001785 |
| Provider Name | Michele L Rogers |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1508812884 PECOS PAC ID: 4486780509 Enrollment ID: I20181102000270 |
| Provider Name | Brittani Rushing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255813754 PECOS PAC ID: 2365786183 Enrollment ID: I20181205003115 |
| Provider Name | Shawn T Stone |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891040689 PECOS PAC ID: 6103103569 Enrollment ID: I20190111001262 |
| Provider Name | Kathryn Cambron |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396749867 PECOS PAC ID: 8224016530 Enrollment ID: I20190114000247 |
| Provider Name | David Scott Henley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770518128 PECOS PAC ID: 2769374032 Enrollment ID: I20190115000657 |
| Provider Name | Kirsten Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659727725 PECOS PAC ID: 2668719170 Enrollment ID: I20190122002779 |
| Provider Name | Thomas Samuel Ahrend |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1841581030 PECOS PAC ID: 4385958834 Enrollment ID: I20190130000585 |
| Provider Name | Nissa Harrington |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1891247466 PECOS PAC ID: 1254679939 Enrollment ID: I20190205003583 |
| Provider Name | Melinda Kelsey |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1700308194 PECOS PAC ID: 8729326368 Enrollment ID: I20190206002866 |
| Provider Name | Kyle Daniel Forgety |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477020329 PECOS PAC ID: 9739427824 Enrollment ID: I20190215000236 |
| Provider Name | Morgan Nicole Dickerson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295262293 PECOS PAC ID: 9133468333 Enrollment ID: I20190306001137 |
| Provider Name | Timothy Conner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750385357 PECOS PAC ID: 6709784119 Enrollment ID: I20190501001441 |
| Provider Name | Kristen Warnock |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194019984 PECOS PAC ID: 9638317746 Enrollment ID: I20190508001815 |
| Provider Name | Teresa M Shavney |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1023016268 PECOS PAC ID: 7315040508 Enrollment ID: I20190522000168 |
| Provider Name | John Jules Schipul |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790912707 PECOS PAC ID: 1254596943 Enrollment ID: I20190620001366 |
| Provider Name | Pamela Grafton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568967602 PECOS PAC ID: 5294064127 Enrollment ID: I20190903000208 |
| Provider Name | John Long |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1396195277 PECOS PAC ID: 4981958220 Enrollment ID: I20190910001098 |
| Provider Name | Tyrone H Philipson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407288756 PECOS PAC ID: 3274840582 Enrollment ID: I20190926003457 |
| Provider Name | Abby Lynn Crow |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1275174435 PECOS PAC ID: 7618209859 Enrollment ID: I20191021003449 |
| Provider Name | Bret Wilmon |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1285289694 PECOS PAC ID: 1254663099 Enrollment ID: I20191029001613 |
| Provider Name | Natalie Alise Brixey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316203938 PECOS PAC ID: 1153630850 Enrollment ID: I20191111000896 |
| Provider Name | Shannon L St. Clair |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881030997 PECOS PAC ID: 3678714268 Enrollment ID: I20191118002958 |
| Provider Name | Jarret Kuo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720228778 PECOS PAC ID: 0446495626 Enrollment ID: I20191125001132 |
| Provider Name | Jacob Hollenbeck |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952891434 PECOS PAC ID: 8426481821 Enrollment ID: I20191125001677 |
| Provider Name | Allison Nazinitsky |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1922324011 PECOS PAC ID: 5092020313 Enrollment ID: I20191203002142 |
| Provider Name | Sommer Leeann Millard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205478682 PECOS PAC ID: 3779911706 Enrollment ID: I20200325001034 |
| Provider Name | Zane Kalter |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649280041 PECOS PAC ID: 5597929687 Enrollment ID: I20200403002187 |
| Provider Name | Christopher Arthur Goodwill |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073976791 PECOS PAC ID: 7315295334 Enrollment ID: I20200601000861 |
| Provider Name | Jonathan Paul Walther |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1205365137 PECOS PAC ID: 3971926320 Enrollment ID: I20200702000750 |
| Provider Name | Sikandar Mesiya |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1407830342 PECOS PAC ID: 8921053398 Enrollment ID: I20200717000364 |
| Provider Name | Pramoda Koduru |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1992090542 PECOS PAC ID: 6800142993 Enrollment ID: I20200721001903 |
| Provider Name | Jennifer D Sims |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730720723 PECOS PAC ID: 0042646093 Enrollment ID: I20200721004393 |
| Provider Name | Fang Yu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811159296 PECOS PAC ID: 9830214154 Enrollment ID: I20200723002419 |
| Provider Name | Beth Feather Mittelstet |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477081099 PECOS PAC ID: 2264857028 Enrollment ID: I20200811000489 |
| Provider Name | Dale Edwards |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1154316701 PECOS PAC ID: 2466594783 Enrollment ID: I20200818003597 |
| Provider Name | Joe T Landrum |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1366480998 PECOS PAC ID: 4880614734 Enrollment ID: I20200825002958 |
| Provider Name | Lisa Hoffman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467593210 PECOS PAC ID: 9436203767 Enrollment ID: I20200921000705 |
| Provider Name | Feras Jalab |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104104637 PECOS PAC ID: 5092134361 Enrollment ID: I20201006002125 |
| Provider Name | Jake Vrdoljak |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619976230 PECOS PAC ID: 8527253400 Enrollment ID: I20201109000080 |
| Provider Name | Tina S Johnston |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1295336683 PECOS PAC ID: 7618388133 Enrollment ID: I20201204000163 |
| Provider Name | Amanda Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700361110 PECOS PAC ID: 3072850049 Enrollment ID: I20201204001076 |
| Provider Name | Asghar Ali |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376070383 PECOS PAC ID: 2961771928 Enrollment ID: I20201214001895 |
| Provider Name | Justin Rammage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609330968 PECOS PAC ID: 8921347980 Enrollment ID: I20210125002275 |
| Provider Name | Kevin W Marcum |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619166675 PECOS PAC ID: 0042480303 Enrollment ID: I20210309002840 |
| Provider Name | Laura Coleen Byous |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1013509728 PECOS PAC ID: 2466868609 Enrollment ID: I20210312000285 |
| Provider Name | Yundeok Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588286892 PECOS PAC ID: 1759797897 Enrollment ID: I20210315002468 |
| Provider Name | Nedal Elass |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437546140 PECOS PAC ID: 2264746858 Enrollment ID: I20210329002011 |
| Provider Name | Karissa Dawn Rowley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831736347 PECOS PAC ID: 3476961673 Enrollment ID: I20210427002066 |
| Provider Name | Zi Rong Xu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114258191 PECOS PAC ID: 3173657624 Enrollment ID: I20210519001495 |
| Provider Name | Jessica Frankfurt |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1063069417 PECOS PAC ID: 2062811011 Enrollment ID: I20210525002122 |
| Provider Name | Valerie Marie Pack |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1467847921 PECOS PAC ID: 2769766468 Enrollment ID: I20210607001896 |
| Provider Name | Georgina Adjei |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164953147 PECOS PAC ID: 4486991551 Enrollment ID: I20210623000857 |
| Provider Name | John R Stanley |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1659397677 PECOS PAC ID: 0143201129 Enrollment ID: I20210706002790 |
| Provider Name | Shrina Parekh |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1154703270 PECOS PAC ID: 9739484643 Enrollment ID: I20210707003247 |
| Provider Name | Nancy Phan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144727850 PECOS PAC ID: 1658775218 Enrollment ID: I20210804003625 |
| Provider Name | David Deschamps |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1700107869 PECOS PAC ID: 8921227901 Enrollment ID: I20210810000507 |
| Provider Name | Shelly Walters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386078418 PECOS PAC ID: 5597984583 Enrollment ID: I20210816001191 |
| Provider Name | Kale Joseph Hunter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750885109 PECOS PAC ID: 2769732189 Enrollment ID: I20210816002843 |
| Provider Name | Tammy Wheat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811943426 PECOS PAC ID: 0547165326 Enrollment ID: I20210917000734 |
| Provider Name | Mikayla Orr |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1700554383 PECOS PAC ID: 5890192405 Enrollment ID: I20210924000942 |
| Provider Name | Lesley Nicole Keesee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841965787 PECOS PAC ID: 7911304209 Enrollment ID: I20210929002738 |
| Provider Name | Tony G Wallen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932720349 PECOS PAC ID: 7517365794 Enrollment ID: I20211004000667 |
| Provider Name | Ying Tang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619537784 PECOS PAC ID: 7618375288 Enrollment ID: I20211012002323 |
| Provider Name | Ronan Bakker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1013278613 PECOS PAC ID: 1658510342 Enrollment ID: I20211102003031 |
| Provider Name | Charles Paul Mirabile |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326063017 PECOS PAC ID: 7618982166 Enrollment ID: I20211103000146 |
| Provider Name | Jennifer Smith |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1265417687 PECOS PAC ID: 3173550985 Enrollment ID: I20211103002623 |
| Provider Name | Lucretia Barker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1003817172 PECOS PAC ID: 1254323041 Enrollment ID: I20211109000334 |
| Provider Name | David M Pierce |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568826501 PECOS PAC ID: 1355634460 Enrollment ID: I20211129002428 |
| Provider Name | Eric Vincent Harris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053931840 PECOS PAC ID: 5991196198 Enrollment ID: I20211223000524 |
| Provider Name | David Lin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851326557 PECOS PAC ID: 7719984210 Enrollment ID: I20220126000654 |
| Provider Name | Marilynn Joy Holman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538589023 PECOS PAC ID: 7618266610 Enrollment ID: I20220216001844 |
| Provider Name | Ronald Kingsley |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1962471326 PECOS PAC ID: 2668510397 Enrollment ID: I20220411002024 |
| Provider Name | Sheila Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538539374 PECOS PAC ID: 6507167756 Enrollment ID: I20220426000934 |
| Provider Name | Elizabeth Kilmer-sterling |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1881051035 PECOS PAC ID: 7214200658 Enrollment ID: I20220502001982 |
| Provider Name | James Kennedye |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639100035 PECOS PAC ID: 2466427752 Enrollment ID: I20220510001534 |
| Provider Name | Dillon Gillespie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548887029 PECOS PAC ID: 6406263839 Enrollment ID: I20220517001462 |
| Provider Name | Whitney Abbott |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1427311935 PECOS PAC ID: 5193964112 Enrollment ID: I20220520000993 |
| Provider Name | Tammy Jarvis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629074992 PECOS PAC ID: 2961431309 Enrollment ID: I20220615003347 |
| Provider Name | Erin Walling |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568997401 PECOS PAC ID: 7315295730 Enrollment ID: I20220627002077 |
| Provider Name | Aerial Avery |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1194915538 PECOS PAC ID: 0547314403 Enrollment ID: I20220708000020 |
| Provider Name | Jennifer M Minadeo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093007593 PECOS PAC ID: 8820218134 Enrollment ID: I20220712003012 |
| Provider Name | Michael D Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215956768 PECOS PAC ID: 3971674862 Enrollment ID: I20220805001710 |
| Provider Name | Kelly Faltyn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427432764 PECOS PAC ID: 1456783778 Enrollment ID: I20220809000029 |
| Provider Name | Stephen Patrick Gonzalez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811494461 PECOS PAC ID: 4082097977 Enrollment ID: I20220809003868 |
| Provider Name | Reginald Kai Mason |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1699739607 PECOS PAC ID: 2365411873 Enrollment ID: I20220823000484 |
| Provider Name | Zachry Deaton |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1376918268 PECOS PAC ID: 2860776457 Enrollment ID: I20220831000404 |
| Provider Name | Ramona Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659034221 PECOS PAC ID: 9739579533 Enrollment ID: I20220909000902 |
| Provider Name | Anita Rao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174985055 PECOS PAC ID: 6204128903 Enrollment ID: I20220912002779 |
| Provider Name | Jeanie Tryggestad |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255472072 PECOS PAC ID: 1658540802 Enrollment ID: I20221011001409 |
| Provider Name | Lauren Elizabeth Grandpre |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578982393 PECOS PAC ID: 5890056162 Enrollment ID: I20221109002156 |
| Provider Name | Sarah Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245980234 PECOS PAC ID: 2466831011 Enrollment ID: I20221110002908 |
| Provider Name | Steven Gurley |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1972573186 PECOS PAC ID: 1153438981 Enrollment ID: I20221228000559 |
| Provider Name | Cheryl Warren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720550676 PECOS PAC ID: 5193065118 Enrollment ID: I20230113000736 |
| Provider Name | Jack Ryan Norgren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437787553 PECOS PAC ID: 7719358811 Enrollment ID: I20230128000128 |
| Provider Name | Oneica Poole |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508132622 PECOS PAC ID: 8426334244 Enrollment ID: I20230130001575 |
| Provider Name | Alfred Javier Laborde |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770167181 PECOS PAC ID: 1951775410 Enrollment ID: I20230323001891 |
| Provider Name | Craig Stewart |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1124400064 PECOS PAC ID: 0749597003 Enrollment ID: I20230324001249 |
| Provider Name | Johnny J Sacco |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1285607838 PECOS PAC ID: 2668537457 Enrollment ID: I20230330001797 |
| Provider Name | Razek Georges Coussa |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1700362522 PECOS PAC ID: 2769731587 Enrollment ID: I20230411002141 |
| Provider Name | Bajrang Agarwal |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1083701171 PECOS PAC ID: 9830292838 Enrollment ID: I20230508000862 |
| Provider Name | Fadi Alass |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477985497 PECOS PAC ID: 2860789047 Enrollment ID: I20230516001041 |
| Provider Name | Candice M Keyes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891490892 PECOS PAC ID: 7214393214 Enrollment ID: I20230517002038 |
| Provider Name | Akilah Talibah Dunn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003505033 PECOS PAC ID: 8022476175 Enrollment ID: I20230621002606 |
| Provider Name | Dezarae Leto |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1538689047 PECOS PAC ID: 6507139508 Enrollment ID: I20230623000304 |
| Provider Name | Nader Tadros |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144299967 PECOS PAC ID: 9234415167 Enrollment ID: I20230720001270 |
| Provider Name | Ulysses Bowler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942290788 PECOS PAC ID: 2163447731 Enrollment ID: I20230816000011 |
| Provider Name | Manjot K Jassal |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487016424 PECOS PAC ID: 0446558928 Enrollment ID: I20230831002109 |
| Provider Name | Jegan Gabbidon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932764685 PECOS PAC ID: 9133455272 Enrollment ID: I20230912002557 |
| Provider Name | Surendra Pawar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1427098797 PECOS PAC ID: 8325011018 Enrollment ID: I20230912003495 |
| Provider Name | Ronald Bullard |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1376532846 PECOS PAC ID: 3971871831 Enrollment ID: I20230914002927 |
| Provider Name | Kyle Hirschman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801175401 PECOS PAC ID: 2466686126 Enrollment ID: I20230928004073 |
| Provider Name | Stacey Roussell |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770629099 PECOS PAC ID: 1153589965 Enrollment ID: I20231009001090 |
| Provider Name | Stephanie Parker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538135561 PECOS PAC ID: 4082664149 Enrollment ID: I20231010000159 |
| Provider Name | Sean Feinberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104273549 PECOS PAC ID: 3476952557 Enrollment ID: I20231016002789 |
| Provider Name | Alice Jean |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255995155 PECOS PAC ID: 8729435060 Enrollment ID: I20231108002963 |
| Provider Name | Casondra Laurie Millard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184964181 PECOS PAC ID: 2769830017 Enrollment ID: I20231127001878 |
| Provider Name | Amanda Diane Harrington |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1932319811 PECOS PAC ID: 8022466382 Enrollment ID: I20231127002204 |
| Provider Name | Ginger Pippin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881358836 PECOS PAC ID: 5991153215 Enrollment ID: I20231128001199 |
| Provider Name | Elizabeth Langthorn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295227122 PECOS PAC ID: 7113318510 Enrollment ID: I20231128002611 |
| Provider Name | Joshua Henley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255851325 PECOS PAC ID: 9537517792 Enrollment ID: I20231128002920 |
| Provider Name | Jesse Knight |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770740854 PECOS PAC ID: 9133304058 Enrollment ID: I20231130002662 |
| Provider Name | Roy M Greenway |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1639219108 PECOS PAC ID: 3375699036 Enrollment ID: I20231201002269 |
| Provider Name | Jeni Presley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003279746 PECOS PAC ID: 9436507316 Enrollment ID: I20231204001036 |
| Provider Name | William Ryan Rice |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124604434 PECOS PAC ID: 4981052875 Enrollment ID: I20231204001478 |
| Provider Name | Brianna Megan Thompson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003364787 PECOS PAC ID: 4981052792 Enrollment ID: I20231204002357 |
| Provider Name | Danny Lamb |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497345649 PECOS PAC ID: 9739538448 Enrollment ID: I20231206003223 |
| Provider Name | Rhonda Elizabeth Oxley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942577903 PECOS PAC ID: 0941659650 Enrollment ID: I20231206003492 |
| Provider Name | Casey Powers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639201759 PECOS PAC ID: 5597114215 Enrollment ID: I20231206004080 |
| Provider Name | Elizabeth Medina |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669047254 PECOS PAC ID: 7416306162 Enrollment ID: I20231207000540 |
| Provider Name | Mercedes Volino |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821648809 PECOS PAC ID: 2163871823 Enrollment ID: I20231207001361 |
| Provider Name | Karen Sue Carr |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740484203 PECOS PAC ID: 9133578792 Enrollment ID: I20231208000875 |
| Provider Name | Meghann Laurel Tillison |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1003326703 PECOS PAC ID: 5799134250 Enrollment ID: I20231208001208 |
| Provider Name | Natalie Evonne Parker |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1730583519 PECOS PAC ID: 5395194856 Enrollment ID: I20231208001377 |
| Provider Name | Rachel Lee Hattensty |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124258249 PECOS PAC ID: 0749639268 Enrollment ID: I20231209000225 |
| Provider Name | Marie Angelene Bennight |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497287452 PECOS PAC ID: 4880043231 Enrollment ID: I20231211000573 |
| Provider Name | Kelsy Riann Knoten |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568240885 PECOS PAC ID: 4688023849 Enrollment ID: I20231213001369 |
| Provider Name | Verda Lynnette Richey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851425656 PECOS PAC ID: 9537396593 Enrollment ID: I20231214002485 |
| Provider Name | Carol Sue Kimbro |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972806149 PECOS PAC ID: 1355790445 Enrollment ID: I20231214002661 |
| Provider Name | Gina Marice Frazier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770852295 PECOS PAC ID: 8820447733 Enrollment ID: I20231218000419 |
| Provider Name | Andrew Ciccarelli |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407893738 PECOS PAC ID: 9436162302 Enrollment ID: I20231220001044 |
| Provider Name | Jennifer Huckabee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689017345 PECOS PAC ID: 3375885551 Enrollment ID: I20231227002551 |
| Provider Name | Paige Vandegrift |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881067502 PECOS PAC ID: 9830549948 Enrollment ID: I20240102000603 |
| Provider Name | Shandi Lynn Martin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447808852 PECOS PAC ID: 1557712387 Enrollment ID: I20240105002722 |
| Provider Name | Karmen Elysia Hignite |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1679344709 PECOS PAC ID: 9234581877 Enrollment ID: I20240118003076 |
| Provider Name | Nicholas Bentley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932173671 PECOS PAC ID: 8820086002 Enrollment ID: I20240124000519 |
| Provider Name | Mark Kijek |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1659336519 PECOS PAC ID: 1355428798 Enrollment ID: I20240130003065 |
| Provider Name | Chiamaka Agbasionwe |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1497218127 PECOS PAC ID: 2668825100 Enrollment ID: I20240131002602 |
| Provider Name | Denis Tereb |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1457493751 PECOS PAC ID: 7517927882 Enrollment ID: I20240205001882 |
| Provider Name | Yuyang Zhang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538304035 PECOS PAC ID: 4880833615 Enrollment ID: I20240206000248 |
| Provider Name | Muneer Janak Desai |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376516021 PECOS PAC ID: 4688645591 Enrollment ID: I20240216001819 |
| Provider Name | Gary Cox |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366022790 PECOS PAC ID: 4981088770 Enrollment ID: I20240326000745 |
| Provider Name | Prakash Karki |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1558351791 PECOS PAC ID: 0840388989 Enrollment ID: I20240501000118 |
| Provider Name | Daniel Burritt |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265775928 PECOS PAC ID: 1951527498 Enrollment ID: I20240508001214 |
| Provider Name | Robert Mcarthur |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1508864877 PECOS PAC ID: 9436190568 Enrollment ID: I20240510001613 |
Ada Family Medical Center, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 530 N Monte Vista St, Ada, OK 74820 Phone: 580-310-9510 Fax: 580-436-4447 | |
Central Oklahoma Family Medical Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 325 N Monte Vista St, Ada, OK 74820 Phone: 580-436-5111 Fax: 580-925-9149 | |
Central Oklahoma Family Medical Center, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 905 Colony Drive Bldg, Ada, OK 74820 Phone: 580-925-3286 | |
Hrh Medical Group, Primary Care Of Ada Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1705 Cradduck Rd, Ada, OK 74820 Phone: 580-304-7017 | |
Myhealth Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1601 N Broadway Ave, Ada, OK 74820 Phone: 405-594-0191 | |
Hale Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 428 E 10th St, 429 E. 10th St, Ada, OK 74820 Phone: 580-310-9755 | |
Family Physician Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1509 Augusta Dr, Ada, OK 74820 Phone: 918-728-4942 Fax: 918-770-8456 |