| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 442 W High St, Bryan, Ohio |
| Authorized Official Name and Position | Diane Conrad (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4196364517 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3702 New Vision Dr Bldg B Fort Wayne IN 46845-1703 Ph: (260) 266-6013 | 442 W High St Bryan OH 43506-1681 Ph: (419) 636-4517 |
| NPI Number | 1619915170 |
|---|---|
| Provider Enumeration Date | 06/04/2006 |
| Last Update Date | 02/25/2019 |
| Medicare PECOS PAC ID | 0941114250 |
|---|---|
| Medicare Enrollment ID | O20031231000726 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619915170 | NPI | - | NPPES |
| 1092419 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Carolyn Jill Sharrock-dorsten |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1659325157 PECOS PAC ID: 6406752906 Enrollment ID: I20031208000268 |
| Provider Name | Susan K Murry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144333808 PECOS PAC ID: 3779562863 Enrollment ID: I20040714000070 |
| Provider Name | Ronald E Music |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508870502 PECOS PAC ID: 2264495753 Enrollment ID: I20041105000424 |
| Provider Name | George T Magill |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972576726 PECOS PAC ID: 9830155431 Enrollment ID: I20041206000636 |
| Provider Name | Kimberly Lynn Dillon |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1376599043 PECOS PAC ID: 2961467725 Enrollment ID: I20050321001003 |
| Provider Name | Rick L Yoder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528097938 PECOS PAC ID: 1456308659 Enrollment ID: I20050331000014 |
| Provider Name | Eric J Lehman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164464046 PECOS PAC ID: 6709833908 Enrollment ID: I20050331000036 |
| Provider Name | Lawrence M Kennedy |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1235255332 PECOS PAC ID: 3678516812 Enrollment ID: I20050608000585 |
| Provider Name | Anthony Gilbert Uribes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720084791 PECOS PAC ID: 6204858178 Enrollment ID: I20051220001014 |
| Provider Name | Joseph Centa |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1902875180 PECOS PAC ID: 8527092295 Enrollment ID: I20060304000006 |
| Provider Name | Jodi L Tinkel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1952341471 PECOS PAC ID: 5799788329 Enrollment ID: I20060821000098 |
| Provider Name | Matthew L Strayer |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1962515478 PECOS PAC ID: 7416951322 Enrollment ID: I20060907000473 |
| Provider Name | Jodi M Arnold |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164535696 PECOS PAC ID: 1355346271 Enrollment ID: I20060928000314 |
| Provider Name | Jeffrey W Schultz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376622027 PECOS PAC ID: 5092815167 Enrollment ID: I20070703000463 |
| Provider Name | Lisa A Pool |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073708434 PECOS PAC ID: 6002902053 Enrollment ID: I20071022000616 |
| Provider Name | Melba M Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851369458 PECOS PAC ID: 5496845497 Enrollment ID: I20071214000020 |
| Provider Name | Jana Bourn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821204124 PECOS PAC ID: 2769562230 Enrollment ID: I20080109000639 |
| Provider Name | Mary Beth Burton |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1063498202 PECOS PAC ID: 1951475573 Enrollment ID: I20080731000001 |
| Provider Name | Kenton J Kamp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427034131 PECOS PAC ID: 6608943691 Enrollment ID: I20080917000034 |
| Provider Name | Damoder R Kesireddy |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1134173925 PECOS PAC ID: 0941351597 Enrollment ID: I20090622000704 |
| Provider Name | Mark S Mabus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407010630 PECOS PAC ID: 6507910965 Enrollment ID: I20090819000507 |
| Provider Name | Peggy H. Watson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376573964 PECOS PAC ID: 6204961501 Enrollment ID: I20100311000676 |
| Provider Name | Jose E Parodi |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1922001908 PECOS PAC ID: 3577476423 Enrollment ID: I20100510000260 |
| Provider Name | Kevin Park |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063441491 PECOS PAC ID: 8123159886 Enrollment ID: I20100624000931 |
| Provider Name | Glen T Seaman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164467635 PECOS PAC ID: 4183755689 Enrollment ID: I20100628000438 |
| Provider Name | Rajender K Ahuja |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1639175565 PECOS PAC ID: 8426092321 Enrollment ID: I20100723000550 |
| Provider Name | Kevin J. Kolovich |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1619093440 PECOS PAC ID: 2365575271 Enrollment ID: I20100729000150 |
| Provider Name | Stanley E. Rowan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447286166 PECOS PAC ID: 0244363158 Enrollment ID: I20100729000180 |
| Provider Name | Hardev S. Sroa |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1326172495 PECOS PAC ID: 9830222363 Enrollment ID: I20100804000085 |
| Provider Name | Samuel Finck |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1669681003 PECOS PAC ID: 8426172123 Enrollment ID: I20100902000169 |
| Provider Name | Mohamed Attia El Nemr |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1619160553 PECOS PAC ID: 9537285259 Enrollment ID: I20100929001639 |
| Provider Name | Belinda Marie Laney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811292659 PECOS PAC ID: 1557541281 Enrollment ID: I20110211000602 |
| Provider Name | Thomas A. Losey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073595757 PECOS PAC ID: 5799960829 Enrollment ID: I20110504000593 |
| Provider Name | Stenneth C Adams |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1982642146 PECOS PAC ID: 5395702104 Enrollment ID: I20110606000408 |
| Provider Name | Vasavi K Reddy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356580294 PECOS PAC ID: 3274658034 Enrollment ID: I20120608000178 |
| Provider Name | Robert F Arrom |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1487664256 PECOS PAC ID: 0941266407 Enrollment ID: I20130207000140 |
| Provider Name | Holli R Zeedyk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710302203 PECOS PAC ID: 3274764899 Enrollment ID: I20140325001225 |
| Provider Name | April Lynn Rock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497178222 PECOS PAC ID: 6103059118 Enrollment ID: I20140428001620 |
| Provider Name | Brian Patrick Bradbee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114332566 PECOS PAC ID: 9335366863 Enrollment ID: I20140807000463 |
| Provider Name | Jennifer Weber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659663052 PECOS PAC ID: 6406094416 Enrollment ID: I20140818001718 |
| Provider Name | Tara L Garza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598165888 PECOS PAC ID: 3678794823 Enrollment ID: I20141031001517 |
| Provider Name | Stephanie N Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922410687 PECOS PAC ID: 8921324518 Enrollment ID: I20150225001350 |
| Provider Name | Lindsay Bradbee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790046779 PECOS PAC ID: 5799923926 Enrollment ID: I20150721001637 |
| Provider Name | Elizabeth F Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326420100 PECOS PAC ID: 5991010506 Enrollment ID: I20150902001736 |
| Provider Name | James A Zimmerman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669748596 PECOS PAC ID: 7012140718 Enrollment ID: I20151007001479 |
| Provider Name | Michael S Nosanov |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1154385805 PECOS PAC ID: 1254398167 Enrollment ID: I20160113001782 |
| Provider Name | Anthony Kaminsky |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1255586301 PECOS PAC ID: 8729212741 Enrollment ID: I20160125001473 |
| Provider Name | Heidi Zuber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396102273 PECOS PAC ID: 1759685100 Enrollment ID: I20160205001122 |
| Provider Name | Anna Trubey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073973889 PECOS PAC ID: 2567752330 Enrollment ID: I20160607001002 |
| Provider Name | Lara L Wynne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336590660 PECOS PAC ID: 4082909577 Enrollment ID: I20160823001613 |
| Provider Name | Tamara D Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477000248 PECOS PAC ID: 1052699238 Enrollment ID: I20161021001188 |
| Provider Name | Denise A Nofziger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609324748 PECOS PAC ID: 8022396217 Enrollment ID: I20161021001676 |
| Provider Name | Vaishali Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033669734 PECOS PAC ID: 2163704917 Enrollment ID: I20170131001728 |
| Provider Name | Sara L Nye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033651302 PECOS PAC ID: 4385927706 Enrollment ID: I20170209001686 |
| Provider Name | Kristina Cline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326583964 PECOS PAC ID: 4789967720 Enrollment ID: I20170216002277 |
| Provider Name | Hanan Ghossein Bazzi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1396189718 PECOS PAC ID: 1951603877 Enrollment ID: I20170614002896 |
| Provider Name | Ryan K Bleck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568877546 PECOS PAC ID: 3779701123 Enrollment ID: I20170616001861 |
| Provider Name | Melissa S Williams |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1891052163 PECOS PAC ID: 8527290378 Enrollment ID: I20170802001628 |
| Provider Name | Christine M Barnett |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1013410687 PECOS PAC ID: 2769745272 Enrollment ID: I20180416002105 |
| Provider Name | David Matthew Cooley |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1083972814 PECOS PAC ID: 5597998567 Enrollment ID: I20180726001415 |
| Provider Name | Tangel Chang |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1306194915 PECOS PAC ID: 6608092010 Enrollment ID: I20180913003003 |
| Provider Name | Michael D Castillo |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1417951211 PECOS PAC ID: 1254370653 Enrollment ID: I20190405001154 |
| Provider Name | Celeste Doreen Lopez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1962468066 PECOS PAC ID: 5496188914 Enrollment ID: I20191213000919 |
| Provider Name | Lydia Marie Schmidt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629519483 PECOS PAC ID: 6709155815 Enrollment ID: I20200820002599 |
| Provider Name | Jacob Lloyd Nafziger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992202394 PECOS PAC ID: 4688939499 Enrollment ID: I20201005001916 |
| Provider Name | Lindsay Marie Roose |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1376158717 PECOS PAC ID: 0547670713 Enrollment ID: I20201029003073 |
| Provider Name | Hannah Mckibben |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1083213714 PECOS PAC ID: 7113338716 Enrollment ID: I20201203002068 |
| Provider Name | Vivek Verma |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1780926022 PECOS PAC ID: 8527308618 Enrollment ID: I20210127003428 |
| Provider Name | Brooke Elaine Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043791635 PECOS PAC ID: 5890032122 Enrollment ID: I20210422000494 |
| Provider Name | Carrie Danielle Cloutier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275112666 PECOS PAC ID: 7810399391 Enrollment ID: I20210706003233 |
| Provider Name | Tonya Renee Gomez |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1780122697 PECOS PAC ID: 9133147713 Enrollment ID: I20211001002367 |
| Provider Name | Mithun Shenoi |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1336482496 PECOS PAC ID: 4284980376 Enrollment ID: I20211029000352 |
| Provider Name | Elise Sadoun |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871733121 PECOS PAC ID: 4183870595 Enrollment ID: I20220203002476 |
| Provider Name | Courtney Jo Anne Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871236711 PECOS PAC ID: 8022494996 Enrollment ID: I20220929001684 |
| Provider Name | Katherine Janeway Murphy |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1508578584 PECOS PAC ID: 7911378161 Enrollment ID: I20230125002765 |
| Provider Name | Khadijeh Zarkoob |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1295705630 PECOS PAC ID: 1153343207 Enrollment ID: I20230207001244 |
| Provider Name | Sara Herstad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629152103 PECOS PAC ID: 5799871315 Enrollment ID: I20230613002574 |
| Provider Name | Bailey Jay Sherburne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306596861 PECOS PAC ID: 7113372772 Enrollment ID: I20231017002112 |
| Provider Name | Ashley Jean Weirauch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265015788 PECOS PAC ID: 6800247297 Enrollment ID: I20240110002545 |
| Provider Name | Joelle Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922529973 PECOS PAC ID: 4183058217 Enrollment ID: I20240423000894 |
| Provider Name | Ransford Commey |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1326329905 PECOS PAC ID: 5799057113 Enrollment ID: I20240515003031 |
| Provider Name | Philip Lowry |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1518949080 PECOS PAC ID: 6305838442 Enrollment ID: I20240523001903 |
| Provider Name | Kimberly D Stewart |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1184608739 PECOS PAC ID: 6406801901 Enrollment ID: I20240523003121 |
| Provider Name | Joy Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427203793 PECOS PAC ID: 8224183488 Enrollment ID: I20240606002196 |
| Provider Name | Tianyi Luo |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1841607710 PECOS PAC ID: 7911124623 Enrollment ID: I20240909003669 |
| Provider Name | Lindsey Ribel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043879158 PECOS PAC ID: 5890023964 Enrollment ID: I20241011003762 |
| Provider Name | Mychelle A Owen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1861486680 PECOS PAC ID: 3971532169 Enrollment ID: I20241017001047 |
| Provider Name | Michael W Conway |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134184781 PECOS PAC ID: 7618966466 Enrollment ID: I20241031000463 |
| Provider Name | Janice Marie Bearer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639945603 PECOS PAC ID: 4688107279 Enrollment ID: I20241105000509 |
| Provider Name | Bridget Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356854749 PECOS PAC ID: 5597025148 Enrollment ID: I20241115001010 |
| Provider Name | Azriel Avezbadalov |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1376833129 PECOS PAC ID: 2961780499 Enrollment ID: I20241121004551 |
| Provider Name | Christine Sue Thomas |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1851570501 PECOS PAC ID: 2668908625 Enrollment ID: I20241213001310 |
Fountain City Medical Clinic Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 324 W High St, Bryan, OH 43506 Phone: 419-636-2525 Fax: 419-636-0632 | |
Community Hospitals And Wellness Centers Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 433 W High St, Bryan, OH 43506 Phone: 419-636-1131 Fax: 419-636-3100 | |
Genesis Eldercare Physician Services Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1104 Wesley Ave, Bryan, OH 43506 Phone: 419-636-5071 | |