| Mercy Clinic Adult Hospitalists - St. Louis, Llc | |
|
621 S New Ballas Rd Suite 3016-b Saint Louis MO 63141-8232 | |
| (314) 251-6339 | |
| (314) 251-4564 |
| Full Name | Mercy Clinic Adult Hospitalists - St. Louis, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 621 S New Ballas Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Jeffrey A. Johnston (PRESIDENT, MERCY HOSPITAL ST. LOUIS) |
| Authorized Official Contact | 3142511932 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercy Clinic Adult Hospitalists - St. Louis, Llc 621 S New Ballas Rd Suite 3016-b Saint Louis MO 63141-8232 Ph: (314) 251-6339 | Mercy Clinic Adult Hospitalists - St. Louis, Llc 621 S New Ballas Rd Suite 3016-b Saint Louis MO 63141-8232 Ph: (314) 251-6339 |
| NPI Number | 1841235108 |
|---|---|
| Provider Enumeration Date | 06/19/2006 |
| Last Update Date | 05/08/2014 |
| Medicare PECOS PAC ID | 6002809944 |
|---|---|
| Medicare Enrollment ID | O20040406001004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841235108 | NPI | - | NPPES |
| 505240002 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Kyeong P Lee |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770511271 PECOS PAC ID: 8820900970 Enrollment ID: I20031105000644 |
| Provider Name | Rodd L Hillard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073509907 PECOS PAC ID: 3476456278 Enrollment ID: I20040129000508 |
| Provider Name | Ksenija Kos |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265454987 PECOS PAC ID: 2961305529 Enrollment ID: I20040130000283 |
| Provider Name | William R Logan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1750311395 PECOS PAC ID: 4789575085 Enrollment ID: I20040324000993 |
| Provider Name | Kelly Ludwig |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992720361 PECOS PAC ID: 2365439437 Enrollment ID: I20040429000783 |
| Provider Name | Laishang P Zhang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235143942 PECOS PAC ID: 7719974682 Enrollment ID: I20040430000804 |
| Provider Name | William O Imbeah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932240249 PECOS PAC ID: 1153311964 Enrollment ID: I20040514000003 |
| Provider Name | Brian P Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487723540 PECOS PAC ID: 9537149984 Enrollment ID: I20040726000005 |
| Provider Name | Ann E Mohart |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710932843 PECOS PAC ID: 5496724643 Enrollment ID: I20040925000058 |
| Provider Name | Darla J Bryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083654073 PECOS PAC ID: 6709834013 Enrollment ID: I20050104000237 |
| Provider Name | Benjamin Y Albano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982603650 PECOS PAC ID: 2264482405 Enrollment ID: I20050126000419 |
| Provider Name | Abdul Muhammud |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780690008 PECOS PAC ID: 5890745509 Enrollment ID: I20050129000167 |
| Provider Name | Monika Prost |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265409122 PECOS PAC ID: 5294786349 Enrollment ID: I20050207000012 |
| Provider Name | Mohammad Asif Qaisrani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245250968 PECOS PAC ID: 6103877923 Enrollment ID: I20050209000122 |
| Provider Name | Daniel A Rey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336288356 PECOS PAC ID: 8123060894 Enrollment ID: I20050524000713 |
| Provider Name | Kamran Baig |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285711747 PECOS PAC ID: 5991618225 Enrollment ID: I20050624000268 |
| Provider Name | Theresa E Hughes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417036047 PECOS PAC ID: 8527094721 Enrollment ID: I20050711000313 |
| Provider Name | Stephen J Wen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447329537 PECOS PAC ID: 9638105331 Enrollment ID: I20050714000072 |
| Provider Name | Pranati Ivaturi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811918071 PECOS PAC ID: 9234165945 Enrollment ID: I20050714000114 |
| Provider Name | Eric V.a. Matlock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093788762 PECOS PAC ID: 9234169194 Enrollment ID: I20050819000602 |
| Provider Name | Malik I Ahmed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770557985 PECOS PAC ID: 5294752648 Enrollment ID: I20051026000073 |
| Provider Name | Gayathri Dundoo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114981008 PECOS PAC ID: 2365457389 Enrollment ID: I20060215000050 |
| Provider Name | Wegdan Andrews |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1972511723 PECOS PAC ID: 6709821267 Enrollment ID: I20060217000622 |
| Provider Name | Matthew Gibfried |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104887728 PECOS PAC ID: 7618985920 Enrollment ID: I20060329000021 |
| Provider Name | Howis Yvette Aros |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1033126156 PECOS PAC ID: 8628071214 Enrollment ID: I20060822000108 |
| Provider Name | Govindarajulu Nagaldinne |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316968779 PECOS PAC ID: 5092777383 Enrollment ID: I20060922000135 |
| Provider Name | Sean Gravely |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134295009 PECOS PAC ID: 3072615772 Enrollment ID: I20070227000544 |
| Provider Name | Rachel Keech |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558589572 PECOS PAC ID: 8224137187 Enrollment ID: I20070619000334 |
| Provider Name | Basem Abdeen |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1366545675 PECOS PAC ID: 0840382909 Enrollment ID: I20070821000022 |
| Provider Name | Anna M Conti |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1275731267 PECOS PAC ID: 0446342299 Enrollment ID: I20070823000910 |
| Provider Name | Binu S Mathew |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740323617 PECOS PAC ID: 8921194655 Enrollment ID: I20071011000103 |
| Provider Name | Matthew Stewart Wilson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649392796 PECOS PAC ID: 9830277573 Enrollment ID: I20080422000525 |
| Provider Name | Jordan A Freie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366592925 PECOS PAC ID: 3779504394 Enrollment ID: I20080512000266 |
| Provider Name | Karen L Austin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649398926 PECOS PAC ID: 3274606033 Enrollment ID: I20080728000067 |
| Provider Name | Jason D Dausman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235187899 PECOS PAC ID: 1759349533 Enrollment ID: I20080916000205 |
| Provider Name | Munier El-beck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376720953 PECOS PAC ID: 2769550268 Enrollment ID: I20081010000504 |
| Provider Name | Anitha Rayani |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1952506875 PECOS PAC ID: 9032279864 Enrollment ID: I20081124000206 |
| Provider Name | Nicole L Duncan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578739561 PECOS PAC ID: 0547322604 Enrollment ID: I20081224000082 |
| Provider Name | Peter W Warner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093756017 PECOS PAC ID: 9133217599 Enrollment ID: I20090105000091 |
| Provider Name | Mariya L Lyubenova Ivanova |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538389390 PECOS PAC ID: 6305909615 Enrollment ID: I20090113000642 |
| Provider Name | Iana P Jeliazkova |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689887432 PECOS PAC ID: 6901960400 Enrollment ID: I20090128000312 |
| Provider Name | Gautam Rohatgi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710065024 PECOS PAC ID: 3971667957 Enrollment ID: I20090206000034 |
| Provider Name | Anjul Sharma |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1720299084 PECOS PAC ID: 9133272081 Enrollment ID: I20090724000658 |
| Provider Name | John J Kakkanathu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346458411 PECOS PAC ID: 3375698491 Enrollment ID: I20090825000716 |
| Provider Name | Caryl Ann Dellinger |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588833925 PECOS PAC ID: 5395802078 Enrollment ID: I20090914000045 |
| Provider Name | Devika Rani Nagaraj |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1881644714 PECOS PAC ID: 2163562661 Enrollment ID: I20091214000633 |
| Provider Name | Attila L Varga |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528011061 PECOS PAC ID: 2769510429 Enrollment ID: I20100517000810 |
| Provider Name | Eduardo Luis Garcia-ferrer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619917101 PECOS PAC ID: 8820128077 Enrollment ID: I20100614000814 |
| Provider Name | Mouner N Salem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124091145 PECOS PAC ID: 4587796701 Enrollment ID: I20100722000874 |
| Provider Name | Peninnah M Mutungi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720251945 PECOS PAC ID: 4183793433 Enrollment ID: I20100802000034 |
| Provider Name | Saad Alkaade |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033433594 PECOS PAC ID: 9436283652 Enrollment ID: I20100810000548 |
| Provider Name | Katherine Lynne Garland |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568634533 PECOS PAC ID: 0941334684 Enrollment ID: I20100817000159 |
| Provider Name | Michael R Banton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619984523 PECOS PAC ID: 4981796588 Enrollment ID: I20100824000118 |
| Provider Name | Farrin A Manian |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1659480283 PECOS PAC ID: 4082713243 Enrollment ID: I20100920000443 |
| Provider Name | Cynthia Renee Hays |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881908986 PECOS PAC ID: 9234254830 Enrollment ID: I20100920001018 |
| Provider Name | Stephanie M Simms |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295879336 PECOS PAC ID: 2163615501 Enrollment ID: I20101019000297 |
| Provider Name | Timothy J Brinker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114181948 PECOS PAC ID: 0749467439 Enrollment ID: I20110606000678 |
| Provider Name | Tomoko R Sampson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346446622 PECOS PAC ID: 5799962999 Enrollment ID: I20110615000131 |
| Provider Name | Wei Wang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952569642 PECOS PAC ID: 0143393637 Enrollment ID: I20110815000641 |
| Provider Name | Venkata Kenguva |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497911374 PECOS PAC ID: 1456523612 Enrollment ID: I20111012000030 |
| Provider Name | Ali Husain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154525707 PECOS PAC ID: 3971674540 Enrollment ID: I20120119000751 |
| Provider Name | Angela D Stratton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033482757 PECOS PAC ID: 3577726298 Enrollment ID: I20120516000535 |
| Provider Name | David A Rempe |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1285742171 PECOS PAC ID: 4082809157 Enrollment ID: I20120829000367 |
| Provider Name | Mikael G Garri |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1306076120 PECOS PAC ID: 7618127978 Enrollment ID: I20121022000586 |
| Provider Name | Joseph Anthony Pantelis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700097128 PECOS PAC ID: 9032200688 Enrollment ID: I20121101000502 |
| Provider Name | Larae Smedley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083988802 PECOS PAC ID: 0648422584 Enrollment ID: I20121128000693 |
| Provider Name | Robert N Long |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639300262 PECOS PAC ID: 7810140662 Enrollment ID: I20130104000141 |
| Provider Name | Ammar Barakat |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1588994289 PECOS PAC ID: 3678766243 Enrollment ID: I20130226000647 |
| Provider Name | Nisha S Shetty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285861294 PECOS PAC ID: 2769627546 Enrollment ID: I20130327000257 |
| Provider Name | David M Smock |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1780850214 PECOS PAC ID: 2466624028 Enrollment ID: I20130328000434 |
| Provider Name | Bikash Acharya |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780850743 PECOS PAC ID: 2567586837 Enrollment ID: I20130611000599 |
| Provider Name | Marnie L Donohoo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164867040 PECOS PAC ID: 7012157431 Enrollment ID: I20130709000158 |
| Provider Name | Ernesto Jose Negron |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841475845 PECOS PAC ID: 8628194347 Enrollment ID: I20130716000900 |
| Provider Name | Gina M Bufe |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1326381765 PECOS PAC ID: 7517108384 Enrollment ID: I20130722000346 |
| Provider Name | Emily M Wood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265743025 PECOS PAC ID: 0547402596 Enrollment ID: I20130805000357 |
| Provider Name | Naveen Bondalapati |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1104147214 PECOS PAC ID: 3779724406 Enrollment ID: I20130816000361 |
| Provider Name | Pooja Sharma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578728218 PECOS PAC ID: 3870736242 Enrollment ID: I20130904000466 |
| Provider Name | Sabrina N Padgett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568777365 PECOS PAC ID: 3072757509 Enrollment ID: I20130923000536 |
| Provider Name | Jason R Collier |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750692232 PECOS PAC ID: 9830324227 Enrollment ID: I20131018001600 |
| Provider Name | Timothy J Bucci |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689985012 PECOS PAC ID: 9335374024 Enrollment ID: I20131105001998 |
| Provider Name | Erica Robinson Mitchell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629366521 PECOS PAC ID: 1557586724 Enrollment ID: I20140701001731 |
| Provider Name | Enquan Gao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295051548 PECOS PAC ID: 0446475198 Enrollment ID: I20140714000586 |
| Provider Name | Nezar Ali El-ruwie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649408659 PECOS PAC ID: 6507082997 Enrollment ID: I20140721001028 |
| Provider Name | Braden F Deloach |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619231248 PECOS PAC ID: 9032336078 Enrollment ID: I20140814001394 |
| Provider Name | Valeria Mcwhorter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265832281 PECOS PAC ID: 0749400182 Enrollment ID: I20141007000025 |
| Provider Name | Mohsin U Qazi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1437461084 PECOS PAC ID: 6507091469 Enrollment ID: I20141205001733 |
| Provider Name | Kiran K Chennareddy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992752869 PECOS PAC ID: 6002846326 Enrollment ID: I20150602001852 |
| Provider Name | Randal Michelson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942571013 PECOS PAC ID: 2567783855 Enrollment ID: I20150611003316 |
| Provider Name | Aaron Anthony Pickrell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295072866 PECOS PAC ID: 7911218938 Enrollment ID: I20150617002424 |
| Provider Name | Rohit R Pawar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013237122 PECOS PAC ID: 8022321587 Enrollment ID: I20150714000133 |
| Provider Name | Yochita Gullapalli |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1235493842 PECOS PAC ID: 3173757028 Enrollment ID: I20150805007040 |
| Provider Name | Mehwish Bilal |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1447596176 PECOS PAC ID: 9830404318 Enrollment ID: I20150812008108 |
| Provider Name | Ryan Kroeger |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801150784 PECOS PAC ID: 9638397326 Enrollment ID: I20150923002776 |
| Provider Name | Mohamad A Albsheri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447508874 PECOS PAC ID: 3779891379 Enrollment ID: I20151001000551 |
| Provider Name | George R Shuert |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376716985 PECOS PAC ID: 4688706393 Enrollment ID: I20160126001604 |
| Provider Name | Erik Aubuchon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558596668 PECOS PAC ID: 2961674064 Enrollment ID: I20160204002169 |
| Provider Name | Heather A Mckeever |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962860510 PECOS PAC ID: 7719281526 Enrollment ID: I20160215000929 |
| Provider Name | Kelechi J N Loynd |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720104888 PECOS PAC ID: 9335308246 Enrollment ID: I20160309000296 |
| Provider Name | Katherine Bleisch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477910719 PECOS PAC ID: 9133425366 Enrollment ID: I20160314001658 |
| Provider Name | Kimberly A Schaefermeier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366814766 PECOS PAC ID: 9436456480 Enrollment ID: I20160318001249 |
| Provider Name | Qin Zhang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831485630 PECOS PAC ID: 8224276019 Enrollment ID: I20160520000405 |
| Provider Name | Onaopemipo Ajiboye |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801155593 PECOS PAC ID: 9436468188 Enrollment ID: I20160531001523 |
| Provider Name | Carolyn M Mcginnis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457714487 PECOS PAC ID: 0648560367 Enrollment ID: I20160608000497 |
| Provider Name | Tracey S Bertram |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720428592 PECOS PAC ID: 8426276163 Enrollment ID: I20160615001626 |
| Provider Name | Musi Ye |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154764132 PECOS PAC ID: 0446579841 Enrollment ID: I20160705001672 |
| Provider Name | David Zenk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194164509 PECOS PAC ID: 8224258728 Enrollment ID: I20160707001732 |
| Provider Name | Pravesh Prabhu Deotale |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710275110 PECOS PAC ID: 2163660283 Enrollment ID: I20160708000233 |
| Provider Name | Tatheer Zohra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457614430 PECOS PAC ID: 5890936033 Enrollment ID: I20160712000138 |
| Provider Name | Fang Wang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841630647 PECOS PAC ID: 0749582575 Enrollment ID: I20160721001171 |
| Provider Name | Nitin Sainani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952745093 PECOS PAC ID: 8123327921 Enrollment ID: I20160803001307 |
| Provider Name | Woo J Moon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578889747 PECOS PAC ID: 1153615737 Enrollment ID: I20160804000350 |
| Provider Name | Eric J Shelley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477999167 PECOS PAC ID: 7315181245 Enrollment ID: I20160804000810 |
| Provider Name | Shannon N Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245696228 PECOS PAC ID: 1153616966 Enrollment ID: I20160818000337 |
| Provider Name | Shirley N Okwuashi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417247693 PECOS PAC ID: 1153638549 Enrollment ID: I20161012000677 |
| Provider Name | Shannon E Witty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013354588 PECOS PAC ID: 3779886189 Enrollment ID: I20161024000412 |
| Provider Name | Anne Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043760259 PECOS PAC ID: 3476833047 Enrollment ID: I20161219000323 |
| Provider Name | Sreenivasulu Bogachenchu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831417070 PECOS PAC ID: 1052508561 Enrollment ID: I20170207001095 |
| Provider Name | Falak Bhatt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588928535 PECOS PAC ID: 1951622760 Enrollment ID: I20170301000326 |
| Provider Name | Pierre E Laughton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578523999 PECOS PAC ID: 2860579778 Enrollment ID: I20170306000491 |
| Provider Name | Danielle N Kramer-smotherman |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1669886677 PECOS PAC ID: 2062630155 Enrollment ID: I20170612002300 |
| Provider Name | Nathan C Robertson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124439252 PECOS PAC ID: 2769784222 Enrollment ID: I20170615001038 |
| Provider Name | Laura J Weitzel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073927794 PECOS PAC ID: 6305115601 Enrollment ID: I20170629001999 |
| Provider Name | Lauren R Counts |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255741351 PECOS PAC ID: 7719280726 Enrollment ID: I20170711001221 |
| Provider Name | Renu Teckchandani |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1831477421 PECOS PAC ID: 6608092119 Enrollment ID: I20170724001413 |
| Provider Name | Rubin Jit Singh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942615992 PECOS PAC ID: 9537466115 Enrollment ID: I20170724002911 |
| Provider Name | Frederick Balch |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154735439 PECOS PAC ID: 6800013368 Enrollment ID: I20170726003403 |
| Provider Name | Shady Hawatmeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922498617 PECOS PAC ID: 8325310725 Enrollment ID: I20170821000203 |
| Provider Name | Anthony J Kruse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306256375 PECOS PAC ID: 6800198227 Enrollment ID: I20170822002319 |
| Provider Name | Steven Nguyen |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1013353663 PECOS PAC ID: 8921371139 Enrollment ID: I20170911002281 |
| Provider Name | Jacob Paul Buhrow |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174967947 PECOS PAC ID: 1951675602 Enrollment ID: I20170920000589 |
| Provider Name | Varundeep K Rakhra |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1346507316 PECOS PAC ID: 6800104571 Enrollment ID: I20171005002056 |
| Provider Name | Kelly Elizabeth Ball |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760935944 PECOS PAC ID: 7810262037 Enrollment ID: I20171013000611 |
| Provider Name | Omar M Kuzez |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558626572 PECOS PAC ID: 8224398102 Enrollment ID: I20180214002376 |
| Provider Name | Wasseem El-aneed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326372053 PECOS PAC ID: 1850533787 Enrollment ID: I20180416001120 |
| Provider Name | Marie Alexandra Muia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669966081 PECOS PAC ID: 5092061622 Enrollment ID: I20180711002988 |
| Provider Name | Ramya Chinnasamy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063708238 PECOS PAC ID: 6709009053 Enrollment ID: I20180724003131 |
| Provider Name | Jahanzeb Khurshid |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417203050 PECOS PAC ID: 1850615337 Enrollment ID: I20180725003489 |
| Provider Name | Mara Kathleen Trautman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922543958 PECOS PAC ID: 5294017463 Enrollment ID: I20180725003522 |
| Provider Name | Mary Beth Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003309147 PECOS PAC ID: 7719235381 Enrollment ID: I20180731000195 |
| Provider Name | Catherine Ash |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861874059 PECOS PAC ID: 4284942806 Enrollment ID: I20180807003033 |
| Provider Name | Changqing Zhao |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700183142 PECOS PAC ID: 5698992311 Enrollment ID: I20180815002287 |
| Provider Name | Joanna I Ramiro |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1376898536 PECOS PAC ID: 3678876406 Enrollment ID: I20180913001194 |
| Provider Name | Zahra Fatimah Hassan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912388695 PECOS PAC ID: 5799036901 Enrollment ID: I20180927002160 |
| Provider Name | Anoushiravan Hakim |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1407237274 PECOS PAC ID: 1557667458 Enrollment ID: I20181016000220 |
| Provider Name | James Mark Spaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811472822 PECOS PAC ID: 2365786076 Enrollment ID: I20181206003600 |
| Provider Name | Erica L Buchalter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770999575 PECOS PAC ID: 6901027911 Enrollment ID: I20190109001878 |
| Provider Name | Ali Etemady-deylamy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760864888 PECOS PAC ID: 4486946076 Enrollment ID: I20190326001069 |
| Provider Name | Meghan Fusz Rodden |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1407054257 PECOS PAC ID: 8022260991 Enrollment ID: I20190509000076 |
| Provider Name | Edmond Nelson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912285446 PECOS PAC ID: 1951541754 Enrollment ID: I20190613000446 |
| Provider Name | Advait Sanjiv Mahulikar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1417377383 PECOS PAC ID: 6305148354 Enrollment ID: I20190701000477 |
| Provider Name | Vedica Sharma |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104277458 PECOS PAC ID: 2365735552 Enrollment ID: I20190709003078 |
| Provider Name | Rada Helen Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508397910 PECOS PAC ID: 7517292311 Enrollment ID: I20190716003738 |
| Provider Name | Amy O Puderbaugh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174878409 PECOS PAC ID: 9931420551 Enrollment ID: I20190722001455 |
| Provider Name | Mohamed M Alwan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1538542634 PECOS PAC ID: 8820390297 Enrollment ID: I20190731002227 |
| Provider Name | Matthew J Crisp |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710337274 PECOS PAC ID: 6608142773 Enrollment ID: I20190805001875 |
| Provider Name | Asm Iftiar Chowdhury |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053759142 PECOS PAC ID: 1355582396 Enrollment ID: I20190805002113 |
| Provider Name | Nichole Michelle Baumgartner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982262580 PECOS PAC ID: 9537496146 Enrollment ID: I20190805003128 |
| Provider Name | Swetha Edla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124403779 PECOS PAC ID: 9638463391 Enrollment ID: I20190807000330 |
| Provider Name | Christopher T Boyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205109675 PECOS PAC ID: 0244518785 Enrollment ID: I20190807001555 |
| Provider Name | Johnson Wong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861846909 PECOS PAC ID: 2466780770 Enrollment ID: I20190824000654 |
| Provider Name | Jessica Leigh Upchurch |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457766974 PECOS PAC ID: 0648564914 Enrollment ID: I20190826000184 |
| Provider Name | Melody Kay Willis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336604370 PECOS PAC ID: 3375871510 Enrollment ID: I20190826001874 |
| Provider Name | Phan Thuc Hang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346894144 PECOS PAC ID: 6305174467 Enrollment ID: I20190827003683 |
| Provider Name | Matrecha Ann Yates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891211553 PECOS PAC ID: 6608104591 Enrollment ID: I20190830001313 |
| Provider Name | Aman Ullah |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1407207624 PECOS PAC ID: 6103103890 Enrollment ID: I20190926003341 |
| Provider Name | Kathryn Shemwell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700263506 PECOS PAC ID: 0749582542 Enrollment ID: I20191007000249 |
| Provider Name | Tammy Lebrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508324351 PECOS PAC ID: 6002147402 Enrollment ID: I20191016002832 |
| Provider Name | Cristian Popu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790148500 PECOS PAC ID: 0345538609 Enrollment ID: I20191018001209 |
| Provider Name | Pangaa Buniya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336690288 PECOS PAC ID: 1951687177 Enrollment ID: I20191022001050 |
| Provider Name | Shanna D Finney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376073536 PECOS PAC ID: 9638501851 Enrollment ID: I20191108001914 |
| Provider Name | Uyen Quynh Kim Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770124745 PECOS PAC ID: 7911330428 Enrollment ID: I20191213000522 |
| Provider Name | Victoria Lynn Alstadt-johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073071585 PECOS PAC ID: 7911235106 Enrollment ID: I20200103002075 |
| Provider Name | Soumil Lele |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1972967602 PECOS PAC ID: 0244666873 Enrollment ID: I20200130001151 |
| Provider Name | Bamidele Ganiyu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073155933 PECOS PAC ID: 1153759394 Enrollment ID: I20200320002762 |
| Provider Name | Brittany Nicole Mora |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336780493 PECOS PAC ID: 1759719990 Enrollment ID: I20200321000087 |
| Provider Name | Melissa Brock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437633716 PECOS PAC ID: 5799026977 Enrollment ID: I20200526002411 |
| Provider Name | Alexandra L Mcdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518501600 PECOS PAC ID: 3375965684 Enrollment ID: I20200615001666 |
| Provider Name | Swati Sood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801247184 PECOS PAC ID: 0446547087 Enrollment ID: I20200626000408 |
| Provider Name | Felix Nau Jr |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1932632544 PECOS PAC ID: 5294005351 Enrollment ID: I20200721001367 |
| Provider Name | Jennifer Bockerstett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801316070 PECOS PAC ID: 4688940794 Enrollment ID: I20200803001450 |
| Provider Name | Talat Syed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588011605 PECOS PAC ID: 4587903414 Enrollment ID: I20200813001825 |
| Provider Name | Lindsey Marie Bushmann |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417498601 PECOS PAC ID: 5193094985 Enrollment ID: I20200814000483 |
| Provider Name | Anne Longtine |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134516701 PECOS PAC ID: 2961716584 Enrollment ID: I20200814001935 |
| Provider Name | Venkataramana Somisetty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215459375 PECOS PAC ID: 0547531345 Enrollment ID: I20200827000455 |
| Provider Name | Alexander Richard Vaynman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275065435 PECOS PAC ID: 0143647701 Enrollment ID: I20200827000474 |
| Provider Name | Christian Hoffman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467062646 PECOS PAC ID: 6800213331 Enrollment ID: I20200831000113 |
| Provider Name | Tiago Araujo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1730600156 PECOS PAC ID: 2466726153 Enrollment ID: I20200901000423 |
| Provider Name | Corey Weicht |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992315857 PECOS PAC ID: 5799103941 Enrollment ID: I20200921000728 |
| Provider Name | Vadim Vasilevski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831629823 PECOS PAC ID: 4082032255 Enrollment ID: I20200921001461 |
| Provider Name | Ramza Haque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619406410 PECOS PAC ID: 8022437151 Enrollment ID: I20200923001259 |
| Provider Name | Pearce W Mundhenke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679003388 PECOS PAC ID: 5496021057 Enrollment ID: I20201006001246 |
| Provider Name | Ian Leonard Pearson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225490881 PECOS PAC ID: 1658665211 Enrollment ID: I20201016001417 |
| Provider Name | James Hollis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710092721 PECOS PAC ID: 9032387196 Enrollment ID: I20201104002909 |
| Provider Name | Chisom Eze |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821527649 PECOS PAC ID: 6002187333 Enrollment ID: I20201130002054 |
| Provider Name | Garwen Chen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972959617 PECOS PAC ID: 1850627001 Enrollment ID: I20210113001805 |
| Provider Name | Carolyn Hilliard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922488261 PECOS PAC ID: 1153634530 Enrollment ID: I20210201002777 |
| Provider Name | Juan Ramos-canseco |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1003194549 PECOS PAC ID: 5698045979 Enrollment ID: I20210504001119 |
| Provider Name | Krishna Syamala |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164838017 PECOS PAC ID: 2567775398 Enrollment ID: I20210713001327 |
| Provider Name | Kathryn Emily Harvey-feldewerth |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700370996 PECOS PAC ID: 2668722547 Enrollment ID: I20210726002126 |
| Provider Name | Andrew Park |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427113729 PECOS PAC ID: 9931248366 Enrollment ID: I20210726003497 |
| Provider Name | William Frick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396236402 PECOS PAC ID: 6800151481 Enrollment ID: I20210806001585 |
| Provider Name | Wagih Zayed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104302991 PECOS PAC ID: 3072917335 Enrollment ID: I20210809001470 |
| Provider Name | Tariq Halasa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043754039 PECOS PAC ID: 8729482757 Enrollment ID: I20210812000854 |
| Provider Name | Neil Backer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962933911 PECOS PAC ID: 2769732015 Enrollment ID: I20210820000412 |
| Provider Name | Nicole F Hawatmeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497248801 PECOS PAC ID: 3971908336 Enrollment ID: I20210823002505 |
| Provider Name | Joanna Haag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760052310 PECOS PAC ID: 8022413350 Enrollment ID: I20210824002387 |
| Provider Name | Andre Robert Theuerkauf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932693181 PECOS PAC ID: 6709281744 Enrollment ID: I20210830000570 |
| Provider Name | Lingxiao Lu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083135909 PECOS PAC ID: 2365715638 Enrollment ID: I20210913003003 |
| Provider Name | Dorian G Shimotani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407344393 PECOS PAC ID: 5496001042 Enrollment ID: I20210914001756 |
| Provider Name | Nida Jamal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1457701104 PECOS PAC ID: 1355637117 Enrollment ID: I20210915000667 |
| Provider Name | Mohit Harsh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528553799 PECOS PAC ID: 4587061338 Enrollment ID: I20210922000988 |
| Provider Name | Archana Machavarapu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063866374 PECOS PAC ID: 4486984440 Enrollment ID: I20210927002285 |
| Provider Name | Aref Qureini |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437681251 PECOS PAC ID: 8729359526 Enrollment ID: I20210928000370 |
| Provider Name | Vanaja Yedla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710483193 PECOS PAC ID: 4082002084 Enrollment ID: I20211025001346 |
| Provider Name | Rajasekhar Bhoda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144485798 PECOS PAC ID: 6305999012 Enrollment ID: I20211029000272 |
| Provider Name | Tisa Suzanne Ayers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134718893 PECOS PAC ID: 1456740422 Enrollment ID: I20211112000200 |
| Provider Name | Milos Ivanovic |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063901270 PECOS PAC ID: 1254723786 Enrollment ID: I20220113001244 |
| Provider Name | Satya Anilbhai Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669607842 PECOS PAC ID: 2163687179 Enrollment ID: I20220309001658 |
| Provider Name | Meghan Marie Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003577925 PECOS PAC ID: 3779978705 Enrollment ID: I20220309002877 |
| Provider Name | Laxmi Dhakal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598997348 PECOS PAC ID: 0446490056 Enrollment ID: I20220404001148 |
| Provider Name | Nikki Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831346204 PECOS PAC ID: 5294803508 Enrollment ID: I20220413000243 |
| Provider Name | Amanda Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952797383 PECOS PAC ID: 9537478011 Enrollment ID: I20220413001554 |
| Provider Name | Mandy Silver |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437655693 PECOS PAC ID: 0840694634 Enrollment ID: I20220627000794 |
| Provider Name | Daniel Hernandez Gonzalez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427602176 PECOS PAC ID: 4587096185 Enrollment ID: I20220630000428 |
| Provider Name | Hayley A Motowski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124688296 PECOS PAC ID: 3870829096 Enrollment ID: I20220711001548 |
| Provider Name | Akhi Mustari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356901110 PECOS PAC ID: 3274914783 Enrollment ID: I20220714003157 |
| Provider Name | Taimoor Haider |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659924017 PECOS PAC ID: 7214361492 Enrollment ID: I20220714003443 |
| Provider Name | Lucia G Burgess |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336709401 PECOS PAC ID: 8022344241 Enrollment ID: I20220719000700 |
| Provider Name | Jose Luis Vega |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558503458 PECOS PAC ID: 1850583790 Enrollment ID: I20220719000746 |
| Provider Name | John Pocholo Whitaker Tuason |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891347498 PECOS PAC ID: 2769863711 Enrollment ID: I20220721002591 |
| Provider Name | Allison Carpio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649688359 PECOS PAC ID: 5799905592 Enrollment ID: I20220725003110 |
| Provider Name | Kara Elise Nuspl |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932760972 PECOS PAC ID: 3577899640 Enrollment ID: I20220726002431 |
| Provider Name | Basil I Shahin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851951982 PECOS PAC ID: 0446648802 Enrollment ID: I20220802000672 |
| Provider Name | Osarenren Idemudia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467013094 PECOS PAC ID: 0547592370 Enrollment ID: I20220803002477 |
| Provider Name | Ghislain B.k. Tchomobe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720548290 PECOS PAC ID: 7012390479 Enrollment ID: I20220817002166 |
| Provider Name | Anam Aqeel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073178315 PECOS PAC ID: 5799017356 Enrollment ID: I20220817003496 |
| Provider Name | Winnie M Hua |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851850846 PECOS PAC ID: 8527393370 Enrollment ID: I20220822002944 |
| Provider Name | Jessica Eve Kuppler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205561867 PECOS PAC ID: 9436532587 Enrollment ID: I20220823000467 |
| Provider Name | Birju V Amin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821658402 PECOS PAC ID: 0042694069 Enrollment ID: I20220825000360 |
| Provider Name | Tejas N Sangoi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417416256 PECOS PAC ID: 8820322076 Enrollment ID: I20220908000830 |
| Provider Name | Iqra Iqbal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104353614 PECOS PAC ID: 4183994015 Enrollment ID: I20220908001957 |
| Provider Name | Mark Bigg |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750941571 PECOS PAC ID: 6901132190 Enrollment ID: I20220909000891 |
| Provider Name | Alexander Heese |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871056333 PECOS PAC ID: 3577897321 Enrollment ID: I20220910000404 |
| Provider Name | Danni Habtu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508421777 PECOS PAC ID: 8820322704 Enrollment ID: I20220912000316 |
| Provider Name | Khristian Sunga |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417305434 PECOS PAC ID: 5799076543 Enrollment ID: I20220914001686 |
| Provider Name | Matthew Frederic Burke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457811481 PECOS PAC ID: 4082099791 Enrollment ID: I20220916000674 |
| Provider Name | Paulina G Rue |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871055046 PECOS PAC ID: 7315271418 Enrollment ID: I20220921003519 |
| Provider Name | Charu Kolekar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811320856 PECOS PAC ID: 8729336565 Enrollment ID: I20221013002976 |
| Provider Name | Mytri Pokal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811250962 PECOS PAC ID: 0547483893 Enrollment ID: I20221013003227 |
| Provider Name | Vikram Sangani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821438995 PECOS PAC ID: 1052695673 Enrollment ID: I20221017002986 |
| Provider Name | Hilary Christine Von Hoffmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740905868 PECOS PAC ID: 2961879218 Enrollment ID: I20221031000832 |
| Provider Name | Adnan Shahid Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558865097 PECOS PAC ID: 8628324852 Enrollment ID: I20230330002322 |
| Provider Name | Katherine Landmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538814686 PECOS PAC ID: 2860889342 Enrollment ID: I20230413000489 |
| Provider Name | Aditi Lele |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356803548 PECOS PAC ID: 5092042390 Enrollment ID: I20230524000536 |
| Provider Name | Chizor Odibi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477702462 PECOS PAC ID: 9931389772 Enrollment ID: I20230525002831 |
| Provider Name | Bijoy Kar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407207699 PECOS PAC ID: 5193050599 Enrollment ID: I20230628003444 |
| Provider Name | Ram Sanjeev Alur |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386808798 PECOS PAC ID: 5193185270 Enrollment ID: I20230720003309 |
| Provider Name | Chase Meyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154958908 PECOS PAC ID: 0941624001 Enrollment ID: I20230720004003 |
| Provider Name | Cody D Novack |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689290181 PECOS PAC ID: 8022434109 Enrollment ID: I20230728000619 |
| Provider Name | Quang Trong Trung Le |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598285959 PECOS PAC ID: 1658640289 Enrollment ID: I20230803003097 |
| Provider Name | Akash Mandhan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194337428 PECOS PAC ID: 1850752049 Enrollment ID: I20230803004066 |
| Provider Name | Kelley Cassens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942993894 PECOS PAC ID: 6901267111 Enrollment ID: I20230804000543 |
| Provider Name | Edward Wang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386131423 PECOS PAC ID: 0042565160 Enrollment ID: I20230818000570 |
| Provider Name | Collin James Hill |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821614439 PECOS PAC ID: 9133542939 Enrollment ID: I20230824001900 |
| Provider Name | Preston Ernest Mundhenke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407472053 PECOS PAC ID: 7416371836 Enrollment ID: I20230824003166 |
| Provider Name | Abigail Wheeler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720608268 PECOS PAC ID: 4880071869 Enrollment ID: I20230829001188 |
| Provider Name | Ibipo Abdurraheem-salami |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962024323 PECOS PAC ID: 9234504812 Enrollment ID: I20230830001824 |
| Provider Name | Catherine Marie Mciver |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1265867352 PECOS PAC ID: 2668836180 Enrollment ID: I20230915001811 |
| Provider Name | Elizabeth Houston |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225653942 PECOS PAC ID: 4284051905 Enrollment ID: I20230919000457 |
| Provider Name | Samantha Jane Collins |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114555927 PECOS PAC ID: 3072937580 Enrollment ID: I20230928002009 |
| Provider Name | Danielle Andrea Gallet Kukielski |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1508383035 PECOS PAC ID: 8325493778 Enrollment ID: I20231005000461 |
| Provider Name | Kenneth James Shortt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649767294 PECOS PAC ID: 0244564862 Enrollment ID: I20231006000330 |
| Provider Name | Mafaza Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275161796 PECOS PAC ID: 9931523321 Enrollment ID: I20231010001650 |
| Provider Name | Muhaddis Ejaz Ahmad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417576984 PECOS PAC ID: 9436504321 Enrollment ID: I20231012002308 |
| Provider Name | Nedaa M. Husainat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558980037 PECOS PAC ID: 9830544675 Enrollment ID: I20231013000913 |
| Provider Name | Sarah Lynn Ernst |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1811778228 PECOS PAC ID: 8325494370 Enrollment ID: I20231026002536 |
| Provider Name | Kaitlin Isbell |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1043931710 PECOS PAC ID: 1153777172 Enrollment ID: I20231027001097 |
| Provider Name | Hamza Bajwa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326668401 PECOS PAC ID: 6103273727 Enrollment ID: I20231103000570 |
| Provider Name | Tiana J. Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164203303 PECOS PAC ID: 4486098035 Enrollment ID: I20240222000541 |
| Provider Name | Lara Kang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841897394 PECOS PAC ID: 7113366394 Enrollment ID: I20240420000215 |
| Provider Name | Rachel Sauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407254410 PECOS PAC ID: 7517307531 Enrollment ID: I20240424002495 |
St. Louis Center For Preventive And Longevity Medicine, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 777 S New Ballas Rd, Suite 200 E, Saint Louis, MO 63141 Phone: 314-994-1536 Fax: 314-692-0241 | |
Town And Country Primary Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3009 N Ballas Rd, Suite 300a, Saint Louis, MO 63131 Phone: 314-872-8999 | |
Family Care Health Centers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1001 Lynch St, Saint Louis, MO 63118 Phone: 314-531-5444 Fax: 314-531-0063 | |
Wusm Bjc Aco Providers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 660 S Euclid Ave, Campus Box 8081, Saint Louis, MO 63110 Phone: 314-273-0770 | |
Victus Physician Services, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12607 Olive Blvd, Saint Louis, MO 63141 Phone: 314-327-8070 | |
Salvation Army Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2900 Washington Ave, Saint Louis, MO 63103 Phone: 314-898-1700 Fax: 314-814-8542 | |
Dtg Ii Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3819 Tesson Ct, Saint Louis, MO 63123 Phone: 800-268-7713 Fax: 415-704-3294 |