| Cs Pacs 3 Midwest Llc | |
|
425 Lauricella Ct Englewood OH 45322-0340 | |
| (937) 836-5143 | |
| Not Available |
| Full Name | Cs Pacs 3 Midwest Llc |
|---|---|
| Speciality | Hospitalist |
| Location | 425 Lauricella Ct, Englewood, Ohio |
| Authorized Official Name and Position | Sandra Bakerink (DIRECTOR, PROVIDER ENROLLMENT) |
| Authorized Official Contact | 8655001325 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cs Pacs 3 Midwest Llc 1643 Nw 136th Ave Ste 100 Sunrise FL 33323-2857 Ph: (865) 500-1325 | Cs Pacs 3 Midwest Llc 425 Lauricella Ct Englewood OH 45322-0340 Ph: (937) 836-5143 |
| NPI Number | 1972368785 |
|---|---|
| Provider Enumeration Date | 02/20/2024 |
| Last Update Date | 08/12/2024 |
| Medicare PECOS PAC ID | 4183164734 |
|---|---|
| Medicare Enrollment ID | O20240910000889 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972368785 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208M00000X | Hospitalist | (* (Not Available)) | Primary |
| Provider Name | Gary J Palmer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053316893 PECOS PAC ID: 0244274264 Enrollment ID: I20091208000294 |
| Provider Name | Jinyun Wu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447245238 PECOS PAC ID: 3072412493 Enrollment ID: I20100719000228 |
| Provider Name | Robert T Grossmann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053686683 PECOS PAC ID: 5294996021 Enrollment ID: I20120420000667 |
| Provider Name | Laura L Kraus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063869188 PECOS PAC ID: 5496049678 Enrollment ID: I20160810002585 |
| Provider Name | Bobbi Lloyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417443896 PECOS PAC ID: 3870844566 Enrollment ID: I20180919001415 |
| Provider Name | Wayne L Chappelle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720056690 PECOS PAC ID: 9032590021 Enrollment ID: I20220721003881 |
| Provider Name | Adrian Pellegrini |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063415099 PECOS PAC ID: 4486547247 Enrollment ID: I20230912003024 |
| Provider Name | Angel Renfro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487431623 PECOS PAC ID: 3971953704 Enrollment ID: I20231220001362 |
Ohio Post-acute Medical Services 1 Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 425 Lauricella Ct, Englewood, OH 45322 Phone: 937-836-5143 | |
Miami Valley Mt Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5 N Main St, Englewood, OH 45322 Phone: 937-890-8660 | |
R Chunduri Md Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1230 Union Blvd, Englewood, OH 45322 Phone: 937-836-7130 Fax: 937-836-9727 |