| Longville Lakes Clinic | |
|
180 Jordan Lane Longville MN 56655 | |
| (218) 363-3300 | |
| (218) 363-2233 |
| Full Name | Longville Lakes Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 180 Jordan Lane, Longville, Minnesota |
| Authorized Official Name and Position | Katie Berg (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 2185467000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longville Lakes Clinic 320 East Main Street Crosby MN 56441 Ph: (218) 546-7000 | Longville Lakes Clinic 180 Jordan Lane Longville MN 56655 Ph: (218) 363-3300 |
| NPI Number | 1861414518 |
|---|---|
| Provider Enumeration Date | 07/24/2006 |
| Last Update Date | 05/04/2017 |
| Medicare PECOS PAC ID | 9537146550 |
|---|---|
| Medicare Enrollment ID | O20040707000501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861414518 | NPI | - | NPPES |
| 684513400 | Medicaid | MN | |
| 24-3872 | Other | MN | RHC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| Provider Name | John E Mertz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346217874 PECOS PAC ID: 2769396373 Enrollment ID: I20031118000430 |
| Provider Name | Jeffrey F Klassen |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1114951738 PECOS PAC ID: 4981508306 Enrollment ID: I20031126000135 |
| Provider Name | Patricia A Welsh |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417934233 PECOS PAC ID: 6103722111 Enrollment ID: I20031210000668 |
| Provider Name | Angelina G Ausban |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891776837 PECOS PAC ID: 6800797291 Enrollment ID: I20040119000273 |
| Provider Name | Matthew J Risken |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699710954 PECOS PAC ID: 2860481843 Enrollment ID: I20040506001348 |
| Provider Name | Shawn A Roberts |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164407524 PECOS PAC ID: 1850374141 Enrollment ID: I20040609000031 |
| Provider Name | Rachel S Cady |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1467437400 PECOS PAC ID: 3870579006 Enrollment ID: I20040628000756 |
| Provider Name | Michael T Cady |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1265416127 PECOS PAC ID: 9032195268 Enrollment ID: I20040628000778 |
| Provider Name | James A Young |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1538126107 PECOS PAC ID: 1355327362 Enrollment ID: I20040629000447 |
| Provider Name | Thomas J Davis |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1043288269 PECOS PAC ID: 3971404542 Enrollment ID: I20040928000555 |
| Provider Name | Kenneth Hoj |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1053352567 PECOS PAC ID: 5991762239 Enrollment ID: I20041217000501 |
| Provider Name | Kara L Maucieri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497739247 PECOS PAC ID: 6608775457 Enrollment ID: I20050117000362 |
| Provider Name | Mark O Bostrom |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902990419 PECOS PAC ID: 6305745167 Enrollment ID: I20050512000430 |
| Provider Name | Matthew L Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073598421 PECOS PAC ID: 4981640927 Enrollment ID: I20050708000529 |
| Provider Name | Jennifer A Tessmer-tuck |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124088737 PECOS PAC ID: 9739110610 Enrollment ID: I20050831000007 |
| Provider Name | Henry M Dvorak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255330247 PECOS PAC ID: 9739103698 Enrollment ID: I20060118000473 |
| Provider Name | David Wayne Laposky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760446868 PECOS PAC ID: 6305850330 Enrollment ID: I20060130000493 |
| Provider Name | Todd M Greatens |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1518942150 PECOS PAC ID: 6204736143 Enrollment ID: I20060130000791 |
| Provider Name | Paul R Carey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215911391 PECOS PAC ID: 4789584616 Enrollment ID: I20060131000248 |
| Provider Name | Kurtis A Waters |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1568440717 PECOS PAC ID: 7810800539 Enrollment ID: I20060202000354 |
| Provider Name | Aaron T Holley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467489302 PECOS PAC ID: 1254344211 Enrollment ID: I20060718000020 |
| Provider Name | Tracy R Hartmann |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578594842 PECOS PAC ID: 9234132622 Enrollment ID: I20060825000192 |
| Provider Name | Fawn W Atchison |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1366463341 PECOS PAC ID: 9133123581 Enrollment ID: I20060828000156 |
| Provider Name | Katie J Starns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750401428 PECOS PAC ID: 9032215546 Enrollment ID: I20070430000476 |
| Provider Name | Kamran M Karimi |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1215947288 PECOS PAC ID: 8820091481 Enrollment ID: I20070802000235 |
| Provider Name | Lincoln R Roth |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1225063936 PECOS PAC ID: 7810889177 Enrollment ID: I20070913000734 |
| Provider Name | Eileen M Kurpiers |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1992722706 PECOS PAC ID: 3375638570 Enrollment ID: I20071003000320 |
| Provider Name | Jesse A Lind |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1427257393 PECOS PAC ID: 7719077221 Enrollment ID: I20071221000022 |
| Provider Name | Timothy P Lemieur |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1255315008 PECOS PAC ID: 3870492622 Enrollment ID: I20080109000768 |
| Provider Name | Mary B Trombley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457534679 PECOS PAC ID: 4880778943 Enrollment ID: I20080227000711 |
| Provider Name | Wendi A Johnson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1861483711 PECOS PAC ID: 9234204199 Enrollment ID: I20080812000810 |
| Provider Name | Michael K Mccormick |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1972684892 PECOS PAC ID: 2567528417 Enrollment ID: I20090302000595 |
| Provider Name | Sandra K Hanson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1750367512 PECOS PAC ID: 2466501820 Enrollment ID: I20090514000520 |
| Provider Name | Rose M Bankers |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1609017417 PECOS PAC ID: 3072662022 Enrollment ID: I20090521000187 |
| Provider Name | Kristin L Furan-kriesel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790936003 PECOS PAC ID: 3476605833 Enrollment ID: I20090724000152 |
| Provider Name | Jennifer J Burgos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770711863 PECOS PAC ID: 9739232869 Enrollment ID: I20090806000369 |
| Provider Name | Jeanne N Gengerke |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1538351978 PECOS PAC ID: 5698828655 Enrollment ID: I20090810000057 |
| Provider Name | Erik P Severson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1801082854 PECOS PAC ID: 4082768882 Enrollment ID: I20090813000122 |
| Provider Name | Clay D Schulte |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336168905 PECOS PAC ID: 4587708284 Enrollment ID: I20100218000622 |
| Provider Name | George A Kuhlmann |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891770244 PECOS PAC ID: 7416856265 Enrollment ID: I20100329000805 |
| Provider Name | Michael K Wiedell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215911177 PECOS PAC ID: 6901705755 Enrollment ID: I20100329000819 |
| Provider Name | Monica L Goodwin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518942952 PECOS PAC ID: 9234038084 Enrollment ID: I20100329000834 |
| Provider Name | David D Goodwin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033194493 PECOS PAC ID: 5698674455 Enrollment ID: I20100329000863 |
| Provider Name | Robert Kenneth Westin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205810959 PECOS PAC ID: 8729987573 Enrollment ID: I20100329000885 |
| Provider Name | Paul A Severson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1841275294 PECOS PAC ID: 1456250208 Enrollment ID: I20100329000899 |
| Provider Name | Howard M Mccollister |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306820154 PECOS PAC ID: 4880593631 Enrollment ID: I20100329000957 |
| Provider Name | Kristin A Schmidt |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1750366100 PECOS PAC ID: 7315075041 Enrollment ID: I20100517000541 |
| Provider Name | Joseph J Randolph |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164497830 PECOS PAC ID: 5991991424 Enrollment ID: I20101123001095 |
| Provider Name | Bonnie B Schmitz |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1750684908 PECOS PAC ID: 1850575358 Enrollment ID: I20110407000395 |
| Provider Name | Chelsey L Olander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093025009 PECOS PAC ID: 2365626819 Enrollment ID: I20110408000009 |
| Provider Name | Bradley Mccusker |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1386609865 PECOS PAC ID: 2769372952 Enrollment ID: I20110913000337 |
| Provider Name | Camille E Lang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013165851 PECOS PAC ID: 2264603646 Enrollment ID: I20110914000744 |
| Provider Name | Angela C Faulkner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1053503680 PECOS PAC ID: 6305019043 Enrollment ID: I20111025000761 |
| Provider Name | Colin P Ryan |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1851660948 PECOS PAC ID: 5294901765 Enrollment ID: I20120104000721 |
| Provider Name | Andrew M Frankwick |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1679850895 PECOS PAC ID: 0143496372 Enrollment ID: I20120110000277 |
| Provider Name | Gregory J Gavin |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1871862466 PECOS PAC ID: 4284894627 Enrollment ID: I20120322000359 |
| Provider Name | Marcella M Hanson |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1962711523 PECOS PAC ID: 2769644640 Enrollment ID: I20120510000594 |
| Provider Name | Basem Goueli |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1699064089 PECOS PAC ID: 8224288808 Enrollment ID: I20121016000518 |
| Provider Name | Trisha Marie Rau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063762953 PECOS PAC ID: 4183876105 Enrollment ID: I20121219000582 |
| Provider Name | Ruth Thomson Treat |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629209689 PECOS PAC ID: 3678710837 Enrollment ID: I20130507000138 |
| Provider Name | Brenda S Enright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801088505 PECOS PAC ID: 3779633409 Enrollment ID: I20130606000826 |
| Provider Name | Thia M Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588091862 PECOS PAC ID: 2062649536 Enrollment ID: I20131209001597 |
| Provider Name | Kenneth W Dodd |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477811610 PECOS PAC ID: 6901020205 Enrollment ID: I20140606000116 |
| Provider Name | Carter A Casmaer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770875387 PECOS PAC ID: 0941424170 Enrollment ID: I20140610000564 |
| Provider Name | David J Warren |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841587128 PECOS PAC ID: 6204050248 Enrollment ID: I20140613002117 |
| Provider Name | Dimitrios Giannakidis |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1285963793 PECOS PAC ID: 6305061458 Enrollment ID: I20140702002333 |
| Provider Name | Nicholas H Jubert |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225320831 PECOS PAC ID: 4183849110 Enrollment ID: I20140708001787 |
| Provider Name | Ganesh Asaithambi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588807143 PECOS PAC ID: 5698918852 Enrollment ID: I20140717000325 |
| Provider Name | Ryan J Fier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285078576 PECOS PAC ID: 3072739325 Enrollment ID: I20140723001403 |
| Provider Name | Katherine Esse |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1720255367 PECOS PAC ID: 9537385471 Enrollment ID: I20140729001934 |
| Provider Name | Melissa S Dyrdal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932514320 PECOS PAC ID: 1759508948 Enrollment ID: I20140815000233 |
| Provider Name | Jeanette R Montgomery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811972060 PECOS PAC ID: 9830319375 Enrollment ID: I20141003000745 |
| Provider Name | Jamie Lynn Westerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700286150 PECOS PAC ID: 7416177993 Enrollment ID: I20141006000000 |
| Provider Name | Karen M Golombecki |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1265775704 PECOS PAC ID: 8820218209 Enrollment ID: I20141007001193 |
| Provider Name | Hung Canh Le |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982997375 PECOS PAC ID: 5597994616 Enrollment ID: I20141111000516 |
| Provider Name | Donna L Claypool |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912941493 PECOS PAC ID: 7315265717 Enrollment ID: I20150415001152 |
| Provider Name | Laura B Fier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740624501 PECOS PAC ID: 5193045169 Enrollment ID: I20150515000628 |
| Provider Name | Heather A Erickson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1124406848 PECOS PAC ID: 2860712056 Enrollment ID: I20150529001635 |
| Provider Name | Adam R English |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013391515 PECOS PAC ID: 5991010332 Enrollment ID: I20150814012999 |
| Provider Name | Eric David Hyun |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831450170 PECOS PAC ID: 8527374388 Enrollment ID: I20150825004478 |
| Provider Name | Michael Jeffrey Muehlenbein |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1346647013 PECOS PAC ID: 4688980683 Enrollment ID: I20150908000875 |
| Provider Name | Kyle J Heffner |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1780054809 PECOS PAC ID: 7416266457 Enrollment ID: I20151014002009 |
| Provider Name | Abby Jo Murray |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437412681 PECOS PAC ID: 0840509006 Enrollment ID: I20151029000613 |
| Provider Name | Matthew B Singh |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1487029765 PECOS PAC ID: 9638473861 Enrollment ID: I20160209002539 |
| Provider Name | Shannon Marie Sicard |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1114382363 PECOS PAC ID: 1850696279 Enrollment ID: I20160223002177 |
| Provider Name | Joshua Michael Horowitz |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1831482660 PECOS PAC ID: 7012166549 Enrollment ID: I20160624001967 |
| Provider Name | Susan M Moen |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1770894479 PECOS PAC ID: 8729370721 Enrollment ID: I20160712002600 |
| Provider Name | Paige E Holmgren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285013367 PECOS PAC ID: 0941504435 Enrollment ID: I20160809002794 |
| Provider Name | Danielle J Munsterman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053763854 PECOS PAC ID: 5496040834 Enrollment ID: I20160824000234 |
| Provider Name | Wangcai Gao |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1710253752 PECOS PAC ID: 5991000820 Enrollment ID: I20160824002278 |
| Provider Name | Julie A Steinhauser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427312529 PECOS PAC ID: 3678704970 Enrollment ID: I20161221000278 |
| Provider Name | Courtney Elm Anderson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790103471 PECOS PAC ID: 8224327101 Enrollment ID: I20170214001514 |
| Provider Name | Christopher J Kaczmarczyk |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912325689 PECOS PAC ID: 8224337266 Enrollment ID: I20170511001685 |
| Provider Name | Barrett P Wagner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720407612 PECOS PAC ID: 7618275884 Enrollment ID: I20170608000459 |
| Provider Name | Nathan Ho-tai Sit |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619236098 PECOS PAC ID: 1557666401 Enrollment ID: I20170608002269 |
| Provider Name | Leah R Kippes |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1184836322 PECOS PAC ID: 8527131713 Enrollment ID: I20170803002383 |
| Provider Name | Andrew P Loveitt |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1356604961 PECOS PAC ID: 2163794918 Enrollment ID: I20170815000884 |
| Provider Name | Courtenay E Deane |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1720333891 PECOS PAC ID: 2567773666 Enrollment ID: I20171025002100 |
| Provider Name | James Christopher Braunwarth |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1053725440 PECOS PAC ID: 9931403573 Enrollment ID: I20171121003545 |
| Provider Name | Arvydas Urbonas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649312208 PECOS PAC ID: 2062594054 Enrollment ID: I20180103002291 |
| Provider Name | Patrick T Mccarthy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053706622 PECOS PAC ID: 4082913124 Enrollment ID: I20180124002474 |
| Provider Name | Brian M Holmgren |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407238389 PECOS PAC ID: 3779875646 Enrollment ID: I20180706000206 |
| Provider Name | Melissa M Goble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578050928 PECOS PAC ID: 5991051799 Enrollment ID: I20180710001150 |
| Provider Name | Lauren M Phillips |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386174225 PECOS PAC ID: 0446522957 Enrollment ID: I20180807000041 |
| Provider Name | Calvin Tsogmo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1063894293 PECOS PAC ID: 0446550248 Enrollment ID: I20180814001608 |
| Provider Name | Jessica Mudgett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619453115 PECOS PAC ID: 5597016147 Enrollment ID: I20180921000323 |
| Provider Name | Staci Roslansky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023172707 PECOS PAC ID: 1153660188 Enrollment ID: I20190308000622 |
| Provider Name | Kendra D Dodd |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083076681 PECOS PAC ID: 2567755689 Enrollment ID: I20190620003430 |
| Provider Name | Daniel F Lonergan |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1932256898 PECOS PAC ID: 7517099419 Enrollment ID: I20190802000911 |
| Provider Name | Molly J Edmundson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1134769243 PECOS PAC ID: 0042646945 Enrollment ID: I20200213001205 |
| Provider Name | Yvonne B Oppold |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1548205123 PECOS PAC ID: 8729975602 Enrollment ID: I20200508000990 |
| Provider Name | Brent A Schotl |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1356861876 PECOS PAC ID: 9638440639 Enrollment ID: I20200511000827 |
| Provider Name | Kyle R Moore |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1093155442 PECOS PAC ID: 6406136761 Enrollment ID: I20200520001417 |
| Provider Name | Christy E Nagel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114314176 PECOS PAC ID: 6002125366 Enrollment ID: I20200602002529 |
| Provider Name | Joseph D Steffens |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669905618 PECOS PAC ID: 2163792706 Enrollment ID: I20200611001193 |
| Provider Name | Jesse A Oman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104447481 PECOS PAC ID: 1951723683 Enrollment ID: I20200625000243 |
| Provider Name | Reyanna G Massaquoi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1417330531 PECOS PAC ID: 8921300468 Enrollment ID: I20200702001668 |
| Provider Name | James Joseph Stokman |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1477973063 PECOS PAC ID: 0446549752 Enrollment ID: I20200813002975 |
| Provider Name | Ashley L Hanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669098307 PECOS PAC ID: 9234555467 Enrollment ID: I20200818002086 |
| Provider Name | Thomas Michael Kalinoski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881128957 PECOS PAC ID: 7810319910 Enrollment ID: I20200901001324 |
| Provider Name | Harlie R Metag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518485986 PECOS PAC ID: 7719305903 Enrollment ID: I20200921002179 |
| Provider Name | Emily A Hilgers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578176798 PECOS PAC ID: 9830519917 Enrollment ID: I20201009002487 |
| Provider Name | Ann E Johnson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1205299385 PECOS PAC ID: 5294026720 Enrollment ID: I20201014003072 |
| Provider Name | Ashley L Yager |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962029678 PECOS PAC ID: 4082034848 Enrollment ID: I20201015002238 |
| Provider Name | Brandon Reynolds |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1851404016 PECOS PAC ID: 1254333875 Enrollment ID: I20201020002091 |
| Provider Name | Lacey M Running Hawk Stawarski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538401922 PECOS PAC ID: 9931406402 Enrollment ID: I20201030000538 |
| Provider Name | Britta Rae Peterson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1114515939 PECOS PAC ID: 8426462904 Enrollment ID: I20210125000063 |
| Provider Name | Regina L Schimek |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1528664026 PECOS PAC ID: 4981018470 Enrollment ID: I20210125000552 |
| Provider Name | Kyle L Durgin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316444136 PECOS PAC ID: 5092066506 Enrollment ID: I20210324000644 |
| Provider Name | Kyle H Mccormick |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1104405034 PECOS PAC ID: 5395154108 Enrollment ID: I20210507000670 |
| Provider Name | Yasser M Said |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1710195904 PECOS PAC ID: 3375635154 Enrollment ID: I20210520000284 |
| Provider Name | Johanna L Christenson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1700465010 PECOS PAC ID: 0042610065 Enrollment ID: I20210614001404 |
| Provider Name | Kristen A Maylott |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326530593 PECOS PAC ID: 9638425770 Enrollment ID: I20210726002841 |
| Provider Name | Evan Kelly |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1124478458 PECOS PAC ID: 6709164809 Enrollment ID: I20210823000887 |
| Provider Name | Hannah M S Elsenpeter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366939530 PECOS PAC ID: 4880029206 Enrollment ID: I20210826002172 |
| Provider Name | Ryan Fuchs |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174010516 PECOS PAC ID: 8224389739 Enrollment ID: I20210915001419 |
| Provider Name | Karlee J Lafavor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811492234 PECOS PAC ID: 3274885918 Enrollment ID: I20211001002557 |
| Provider Name | Danika K Evans |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972009157 PECOS PAC ID: 9638420557 Enrollment ID: I20211005002126 |
| Provider Name | Nowa Edsel Ajayi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1972034957 PECOS PAC ID: 1254674435 Enrollment ID: I20211006002686 |
| Provider Name | Nicole M Wolle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073285508 PECOS PAC ID: 2769870302 Enrollment ID: I20211101000887 |
| Provider Name | Gina N Schlueter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255991345 PECOS PAC ID: 9032449459 Enrollment ID: I20211102002351 |
| Provider Name | Emma L Kline |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1508519554 PECOS PAC ID: 0143613083 Enrollment ID: I20220217000265 |
| Provider Name | Miranda N Larson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1598405169 PECOS PAC ID: 9133516560 Enrollment ID: I20220503001646 |
| Provider Name | Monica K Larson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093470403 PECOS PAC ID: 8224416730 Enrollment ID: I20220610002050 |
| Provider Name | Ethan T Kraft |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1316471386 PECOS PAC ID: 0244599587 Enrollment ID: I20220614000484 |
| Provider Name | Graham P Fain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457744005 PECOS PAC ID: 7315251188 Enrollment ID: I20220711000422 |
| Provider Name | Alisha F Lindberg |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1508353327 PECOS PAC ID: 5991053993 Enrollment ID: I20220719002409 |
| Provider Name | Lev Lotman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154854644 PECOS PAC ID: 1557606381 Enrollment ID: I20220830000304 |
| Provider Name | Lindsey A Wolff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730816539 PECOS PAC ID: 7911374277 Enrollment ID: I20221031001499 |
| Provider Name | Christine J Soxman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902513062 PECOS PAC ID: 3173992922 Enrollment ID: I20221216002473 |
| Provider Name | Matthew W Houge |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1376260430 PECOS PAC ID: 8527437292 Enrollment ID: I20221220001610 |
| Provider Name | Tesfatsiyon Ergando |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1043884224 PECOS PAC ID: 2163822305 Enrollment ID: I20221228002930 |
| Provider Name | Destiny Brianne Amundson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326765892 PECOS PAC ID: 4284005539 Enrollment ID: I20230124001439 |
| Provider Name | Marcella M Hanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962711523 PECOS PAC ID: 2769644640 Enrollment ID: I20230809001615 |
| Provider Name | Jennifer L Laprise |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790211589 PECOS PAC ID: 5991032039 Enrollment ID: I20230814002390 |
| Provider Name | Rammohan R Sankaraneni |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790942795 PECOS PAC ID: 9830314038 Enrollment ID: I20230822003958 |
| Provider Name | Jacob K Pederson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770243727 PECOS PAC ID: 3072905892 Enrollment ID: I20230907003887 |
| Provider Name | Atlantis D Russ |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1851826374 PECOS PAC ID: 1557625852 Enrollment ID: I20231019002666 |
| Provider Name | Katherine Elizabeth Paul |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1902390073 PECOS PAC ID: 6901291962 Enrollment ID: I20231025000689 |
| Provider Name | Trisha Mykkanen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144092727 PECOS PAC ID: 9436508231 Enrollment ID: I20231205002451 |
| Provider Name | John A Reimer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881377505 PECOS PAC ID: 3779932066 Enrollment ID: I20231212002731 |
| Provider Name | Margaret F Crawford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710076187 PECOS PAC ID: 0749243145 Enrollment ID: I20231222000122 |
| Provider Name | Rebekah L Gorny |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104326636 PECOS PAC ID: 3870848393 Enrollment ID: I20240118002119 |
| Provider Name | John T Berquist |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1699268581 PECOS PAC ID: 1557617552 Enrollment ID: I20240322000867 |