| Pekin Prohealth Inc | |
|
600 S 13th St Suite M Pekin IL 61554-4936 | |
| (309) 353-0825 | |
| (309) 347-1246 |
| Full Name | Pekin Prohealth Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 600 S 13th St, Pekin, Illinois |
| Authorized Official Name and Position | Janet Vandyke (BILLING SUPERVISOR) |
| Authorized Official Contact | 3093530799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pekin Prohealth Inc 600 S 13th St Suite M Pekin IL 61554-4936 Ph: (309) 353-0825 | Pekin Prohealth Inc 600 S 13th St Suite M Pekin IL 61554-4936 Ph: (309) 353-0825 |
| NPI Number | 1932150299 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 03/18/2013 |
| Medicare PECOS PAC ID | 1951214576 |
|---|---|
| Medicare Enrollment ID | O20031110000647 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932150299 | NPI | - | NPPES |
| 09015685 | Other | IL | BLUE CROSS BLUE SHIELD |
| CE8213 | Other | IL | RAIL ROAD MEDICARE |
| CN0361 | Other | IL | RAIL ROAD MEDICARE |
| Provider Name | Jianming Dong |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619981305 PECOS PAC ID: 8527051473 Enrollment ID: I20040406001046 |
| Provider Name | Michael Patrick Honan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255424750 PECOS PAC ID: 6901891753 Enrollment ID: I20040420000230 |
| Provider Name | Abraham H Steinberg |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1285628305 PECOS PAC ID: 2264429059 Enrollment ID: I20040426000813 |
| Provider Name | Riaz H Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003823220 PECOS PAC ID: 5698763639 Enrollment ID: I20040506000256 |
| Provider Name | Syed Omar A Bukhari |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225052434 PECOS PAC ID: 8022096494 Enrollment ID: I20040712000840 |
| Provider Name | Greg J Jun |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043212780 PECOS PAC ID: 7315917606 Enrollment ID: I20040726001146 |
| Provider Name | Richard D Harvey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740259068 PECOS PAC ID: 5092780163 Enrollment ID: I20040901000177 |
| Provider Name | Adel F Mina |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316962749 PECOS PAC ID: 5193786572 Enrollment ID: I20041101000320 |
| Provider Name | Alexander A Adler |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1912929118 PECOS PAC ID: 8123084472 Enrollment ID: I20041208000369 |
| Provider Name | Giovanni Colombo |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1679537831 PECOS PAC ID: 6901856707 Enrollment ID: I20050129000062 |
| Provider Name | Walter S Reid |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1932180387 PECOS PAC ID: 9830177104 Enrollment ID: I20050310000447 |
| Provider Name | Mohammad A Toor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841289691 PECOS PAC ID: 2264426212 Enrollment ID: I20050628000341 |
| Provider Name | Kenneth B Camacho |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1750323424 PECOS PAC ID: 2264455401 Enrollment ID: I20060113000186 |
| Provider Name | Ryan D Schmidgall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548204779 PECOS PAC ID: 1456315977 Enrollment ID: I20060726000071 |
| Provider Name | Kashif S Haque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285679704 PECOS PAC ID: 3476566001 Enrollment ID: I20060726000078 |
| Provider Name | Mourad Alnatour |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891734257 PECOS PAC ID: 0941203483 Enrollment ID: I20060823000039 |
| Provider Name | Vinoda Shanthappa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518986512 PECOS PAC ID: 8729082805 Enrollment ID: I20060901000060 |
| Provider Name | Kelly E Bewsey |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1831198118 PECOS PAC ID: 8123099645 Enrollment ID: I20060921000164 |
| Provider Name | Jayaraj Salimath |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1720020308 PECOS PAC ID: 3274546411 Enrollment ID: I20070822000214 |
| Provider Name | Thomas Kouri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568412773 PECOS PAC ID: 1052490232 Enrollment ID: I20080430000313 |
| Provider Name | Renaldo Jacques |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477528974 PECOS PAC ID: 9739268913 Enrollment ID: I20080430000344 |
| Provider Name | Sahar Halabi |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1003937350 PECOS PAC ID: 9931271764 Enrollment ID: I20080710000424 |
| Provider Name | Mohammed Irfan Shakaib |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225243462 PECOS PAC ID: 6406929280 Enrollment ID: I20080728000185 |
| Provider Name | Jacob Tony |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881815488 PECOS PAC ID: 9830257484 Enrollment ID: I20081025000101 |
| Provider Name | Generoso N Sison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609085273 PECOS PAC ID: 8426118142 Enrollment ID: I20081125000223 |
| Provider Name | Rachel S Grieder |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1598926289 PECOS PAC ID: 8123189495 Enrollment ID: I20081204000635 |
| Provider Name | Eliathamby Kuganeswaran |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1073555488 PECOS PAC ID: 2668537234 Enrollment ID: I20090213000407 |
| Provider Name | Tahir B Ilahi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1194974964 PECOS PAC ID: 2769530211 Enrollment ID: I20090511000393 |
| Provider Name | Paul A Siebert |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1154337236 PECOS PAC ID: 0648329953 Enrollment ID: I20090515000380 |
| Provider Name | Farnaz Nani Moazzam |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1487669735 PECOS PAC ID: 1557410867 Enrollment ID: I20090515000410 |
| Provider Name | Todd A Lanser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376765891 PECOS PAC ID: 2466502828 Enrollment ID: I20090608000102 |
| Provider Name | Housam E Soukieh |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1568422673 PECOS PAC ID: 1254482631 Enrollment ID: I20090624000577 |
| Provider Name | Srihari D Nair |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1295828846 PECOS PAC ID: 4789737487 Enrollment ID: I20090728000644 |
| Provider Name | Rehman Usmani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114170073 PECOS PAC ID: 9638222185 Enrollment ID: I20090730000303 |
| Provider Name | Gulzar Fidai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851398218 PECOS PAC ID: 9133028749 Enrollment ID: I20100108000384 |
| Provider Name | Zahangir Khaled |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356316715 PECOS PAC ID: 5294863650 Enrollment ID: I20100506000233 |
| Provider Name | Tracy Lynn Schierer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275869240 PECOS PAC ID: 7911036223 Enrollment ID: I20100525000837 |
| Provider Name | Jeffrey Hallett |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1760499313 PECOS PAC ID: 9335278530 Enrollment ID: I20100526000942 |
| Provider Name | William Charles Hicok |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457326944 PECOS PAC ID: 5890827687 Enrollment ID: I20100714000315 |
| Provider Name | Vaughn E Hanna |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1912912213 PECOS PAC ID: 6406980275 Enrollment ID: I20100816000420 |
| Provider Name | Noor A Khaiser |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1487696126 PECOS PAC ID: 5193840320 Enrollment ID: I20100913000117 |
| Provider Name | Robert Allan Lizer |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1184624280 PECOS PAC ID: 5496870651 Enrollment ID: I20100913000462 |
| Provider Name | Shahid Wazir |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548440803 PECOS PAC ID: 7315139961 Enrollment ID: I20101014000501 |
| Provider Name | Michael R Treanor |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1255375200 PECOS PAC ID: 4789877614 Enrollment ID: I20101022001055 |
| Provider Name | Scott Y Wu |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1760426308 PECOS PAC ID: 7911190855 Enrollment ID: I20101022001115 |
| Provider Name | Donald E Penn |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1780628388 PECOS PAC ID: 7810182029 Enrollment ID: I20101113000232 |
| Provider Name | Anil K Reddivari |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1164687968 PECOS PAC ID: 0648467365 Enrollment ID: I20101207001201 |
| Provider Name | Abdullah M Al-rashdan |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1588831721 PECOS PAC ID: 8628142882 Enrollment ID: I20101214000978 |
| Provider Name | Thomas R Rossi |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1851320238 PECOS PAC ID: 6305736851 Enrollment ID: I20101217000859 |
| Provider Name | David L Crawford |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306874128 PECOS PAC ID: 0941190490 Enrollment ID: I20101221000112 |
| Provider Name | Parth Mehta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750557815 PECOS PAC ID: 1759579568 Enrollment ID: I20101221000498 |
| Provider Name | Shams B Ilahi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801058409 PECOS PAC ID: 4284823220 Enrollment ID: I20110106000832 |
| Provider Name | Timothy J Lawless |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982679569 PECOS PAC ID: 9032308960 Enrollment ID: I20110107000714 |
| Provider Name | Ram L Goel |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1255387007 PECOS PAC ID: 0941489058 Enrollment ID: I20110121000283 |
| Provider Name | Omar Khokhar |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1386865244 PECOS PAC ID: 9133276728 Enrollment ID: I20110209001099 |
| Provider Name | Raj Haribhai Ughreja |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982857926 PECOS PAC ID: 9830367788 Enrollment ID: I20110719000749 |
| Provider Name | Jamaluddin F Amanullah |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1184673147 PECOS PAC ID: 4385622323 Enrollment ID: I20110802000270 |
| Provider Name | Yves R Makhoul |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1952544330 PECOS PAC ID: 9931372679 Enrollment ID: I20111025000765 |
| Provider Name | Eric M Cox |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1821275074 PECOS PAC ID: 4284800749 Enrollment ID: I20120104000605 |
| Provider Name | Heather Lynn Jefford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881906410 PECOS PAC ID: 6800050402 Enrollment ID: I20120612000120 |
| Provider Name | Mohammed A Mubeen |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1578720777 PECOS PAC ID: 8325203474 Enrollment ID: I20120622000610 |
| Provider Name | Kurt L Glesne |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1346508280 PECOS PAC ID: 5698924959 Enrollment ID: I20121001000310 |
| Provider Name | Mansoor Ahmad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194059600 PECOS PAC ID: 4385898154 Enrollment ID: I20130201000119 |
| Provider Name | Rehan Mohammed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356511901 PECOS PAC ID: 9739357179 Enrollment ID: I20130502000308 |
| Provider Name | C Diane Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942503602 PECOS PAC ID: 8527205681 Enrollment ID: I20130508000439 |
| Provider Name | Avni Gupta |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1215184247 PECOS PAC ID: 0840439683 Enrollment ID: I20130626000798 |
| Provider Name | Aneesh Neekhra |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134384548 PECOS PAC ID: 6406910660 Enrollment ID: I20130710000192 |
| Provider Name | Robin A Alley |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659689461 PECOS PAC ID: 8325272834 Enrollment ID: I20131015001924 |
| Provider Name | Ibrahim Shamsi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710207105 PECOS PAC ID: 5597991646 Enrollment ID: I20131119000722 |
| Provider Name | Maytee Boonyapredee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235314501 PECOS PAC ID: 6406912492 Enrollment ID: I20140319000153 |
| Provider Name | Shiraz A Khaiser |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1568681740 PECOS PAC ID: 8224176615 Enrollment ID: I20140612000946 |
| Provider Name | John E Player |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1285965905 PECOS PAC ID: 9931235801 Enrollment ID: I20140616001777 |
| Provider Name | Lihua Du |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215198320 PECOS PAC ID: 7315100450 Enrollment ID: I20140624001764 |
| Provider Name | Venkat R Kakollu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1447681044 PECOS PAC ID: 7315163565 Enrollment ID: I20140723001822 |
| Provider Name | Afshin Ahmed Khaiser |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1255630646 PECOS PAC ID: 8325267255 Enrollment ID: I20140908002441 |
| Provider Name | Fizza Deen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952664013 PECOS PAC ID: 3072839976 Enrollment ID: I20150312001505 |
| Provider Name | Benjamin Charles Hanshaw |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1861706855 PECOS PAC ID: 8729391065 Enrollment ID: I20150716000486 |
| Provider Name | Shriram Lokare |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1497057905 PECOS PAC ID: 0345477238 Enrollment ID: I20150716002617 |
| Provider Name | Fadi Aljabi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1790890556 PECOS PAC ID: 0648279919 Enrollment ID: I20150930000027 |
| Provider Name | Jonathan A Rider |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437526852 PECOS PAC ID: 0648588186 Enrollment ID: I20151001002353 |
| Provider Name | Janelle Arletta Fenski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790154532 PECOS PAC ID: 9739499336 Enrollment ID: I20151111001741 |
| Provider Name | Lionel J Malebranche |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1033390521 PECOS PAC ID: 0244456267 Enrollment ID: I20160107001231 |
| Provider Name | Theresa Abbadusky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265892046 PECOS PAC ID: 6507164472 Enrollment ID: I20160408000540 |
| Provider Name | Jami M Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144606195 PECOS PAC ID: 6002108693 Enrollment ID: I20160629002488 |
| Provider Name | Jaymon B Patel |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1386084044 PECOS PAC ID: 1557682317 Enrollment ID: I20160801000888 |
| Provider Name | Thomas Choorapokayil George |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922448018 PECOS PAC ID: 5294029666 Enrollment ID: I20160808001566 |
| Provider Name | Janell K Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265883490 PECOS PAC ID: 5496049363 Enrollment ID: I20160816001220 |
| Provider Name | Anota Akofu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215376140 PECOS PAC ID: 9537301395 Enrollment ID: I20160829000580 |
| Provider Name | Kimberly Kristine Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154876498 PECOS PAC ID: 2668769928 Enrollment ID: I20160929002498 |
| Provider Name | John Voris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790125193 PECOS PAC ID: 7315268109 Enrollment ID: I20161025001149 |
| Provider Name | Christian Stremmel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710437249 PECOS PAC ID: 3476832924 Enrollment ID: I20161128001258 |
| Provider Name | Jana L Huston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801345160 PECOS PAC ID: 8224318324 Enrollment ID: I20161207001146 |
| Provider Name | Alicia C Layton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053854323 PECOS PAC ID: 2062792062 Enrollment ID: I20161209000024 |
| Provider Name | Mark Richard Stivers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417943523 PECOS PAC ID: 1951386184 Enrollment ID: I20170120002395 |
| Provider Name | Elizabeth Adkison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225574007 PECOS PAC ID: 3870875792 Enrollment ID: I20170127002387 |
| Provider Name | Francesco Vetri |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1427323864 PECOS PAC ID: 1153631239 Enrollment ID: I20170518002108 |
| Provider Name | Mika Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063846467 PECOS PAC ID: 8022244797 Enrollment ID: I20170615000706 |
| Provider Name | Thomas Luft |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659329845 PECOS PAC ID: 7012910789 Enrollment ID: I20170719000364 |
| Provider Name | Justin Lee Fischer |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1730456914 PECOS PAC ID: 0143514331 Enrollment ID: I20170801003819 |
| Provider Name | Sarah J Chalmers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740612241 PECOS PAC ID: 8426379355 Enrollment ID: I20170809000854 |
| Provider Name | Rachel Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669996781 PECOS PAC ID: 4688948375 Enrollment ID: I20170919002481 |
| Provider Name | Praveen R Anegondhi Sudhindra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225340045 PECOS PAC ID: 5294009502 Enrollment ID: I20170926002361 |
| Provider Name | Nada Farooq |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083020796 PECOS PAC ID: 9133495302 Enrollment ID: I20171017000824 |
| Provider Name | Laura Rachel Jarvis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578081790 PECOS PAC ID: 8921374455 Enrollment ID: I20171027000106 |
| Provider Name | Olaniyi O Osofisan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1447333554 PECOS PAC ID: 9638156664 Enrollment ID: I20171213000125 |
| Provider Name | Rohit Mehta |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1437339058 PECOS PAC ID: 5991954372 Enrollment ID: I20180118002438 |
| Provider Name | Karen Becker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306344650 PECOS PAC ID: 1951662683 Enrollment ID: I20180221000459 |
| Provider Name | Matthew Culp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285142281 PECOS PAC ID: 3870855729 Enrollment ID: I20180313001604 |
| Provider Name | Jamie Beversdorf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427256965 PECOS PAC ID: 2163608605 Enrollment ID: I20180508002353 |
| Provider Name | Jon Soble |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1487639969 PECOS PAC ID: 2365355344 Enrollment ID: I20180517001392 |
| Provider Name | Lori Farris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699262550 PECOS PAC ID: 8022365477 Enrollment ID: I20180717002653 |
| Provider Name | Jessica Schlupp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184113318 PECOS PAC ID: 5890042857 Enrollment ID: I20180720003021 |
| Provider Name | Melinda Bahler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033608872 PECOS PAC ID: 1355699521 Enrollment ID: I20180803000884 |
| Provider Name | Eric L Lo |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1497782023 PECOS PAC ID: 8123193208 Enrollment ID: I20180806002918 |
| Provider Name | Nicholas Robert Grieco |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649657685 PECOS PAC ID: 8921302589 Enrollment ID: I20180816000479 |
| Provider Name | Sheena Mbachu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1225423841 PECOS PAC ID: 3577873249 Enrollment ID: I20180828003032 |
| Provider Name | Kristen Dent |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881072791 PECOS PAC ID: 8527373604 Enrollment ID: I20180829000520 |
| Provider Name | Eben E Tucker |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1437273166 PECOS PAC ID: 2365356847 Enrollment ID: I20180911002534 |
| Provider Name | Matthew R Sehring |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1629458526 PECOS PAC ID: 0345554085 Enrollment ID: I20180913001568 |
| Provider Name | Leah E Hulse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285117820 PECOS PAC ID: 3779835053 Enrollment ID: I20181015002885 |
| Provider Name | Kevin Dean Spangler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659790350 PECOS PAC ID: 9739404591 Enrollment ID: I20181106000245 |
| Provider Name | Irfan Choudhry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124369855 PECOS PAC ID: 3577860295 Enrollment ID: I20181107001154 |
| Provider Name | Robert Aranson |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1407894728 PECOS PAC ID: 4486613551 Enrollment ID: I20181210001695 |
| Provider Name | Courtney Dawn Edsall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558830851 PECOS PAC ID: 6103161898 Enrollment ID: I20181228000479 |
| Provider Name | William A Johnson |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1699933903 PECOS PAC ID: 8224153168 Enrollment ID: I20190109001995 |
| Provider Name | Srikanth Markapuram |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720343072 PECOS PAC ID: 2567770589 Enrollment ID: I20190114000214 |
| Provider Name | Andrea Volkerding |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1922412717 PECOS PAC ID: 8527364819 Enrollment ID: I20190305001298 |
| Provider Name | Delbert C Rudy |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1386630481 PECOS PAC ID: 9931247723 Enrollment ID: I20190305001365 |
| Provider Name | Muhammad Deen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841649845 PECOS PAC ID: 5890089346 Enrollment ID: I20190423000599 |
| Provider Name | Kimberly Helmkamp |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1447633128 PECOS PAC ID: 8325354905 Enrollment ID: I20190516000640 |
| Provider Name | Adetoun A Adeyemi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1154784809 PECOS PAC ID: 6406142520 Enrollment ID: I20190626002323 |
| Provider Name | Umair Ahmed |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134579402 PECOS PAC ID: 8820380918 Enrollment ID: I20190813002335 |
| Provider Name | Bilal Mohamed |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1669822318 PECOS PAC ID: 8325330509 Enrollment ID: I20190830001717 |
| Provider Name | Dhaval R Save |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659703759 PECOS PAC ID: 3971809245 Enrollment ID: I20190906000924 |
| Provider Name | Raeda Alshantti |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376092288 PECOS PAC ID: 5597096883 Enrollment ID: I20191017002520 |
| Provider Name | Bhumik Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689938797 PECOS PAC ID: 8527373711 Enrollment ID: I20200603001298 |
| Provider Name | Jantsen R Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174054415 PECOS PAC ID: 2567733934 Enrollment ID: I20200916001135 |
| Provider Name | Moaviz B Badshah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114466885 PECOS PAC ID: 8729323050 Enrollment ID: I20200929002358 |
| Provider Name | Melissa M Florido |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316473804 PECOS PAC ID: 0042584716 Enrollment ID: I20200930001689 |
| Provider Name | Ryan Timothy Funk |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1720460363 PECOS PAC ID: 5991010050 Enrollment ID: I20201014003737 |
| Provider Name | Saqib Walayat |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1649729732 PECOS PAC ID: 2264710128 Enrollment ID: I20201118001384 |
| Provider Name | Akash Goel |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1659630192 PECOS PAC ID: 0941552632 Enrollment ID: I20210322000539 |
| Provider Name | Sami Mohammed Abdus |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1801162078 PECOS PAC ID: 4385952746 Enrollment ID: I20210414002034 |
| Provider Name | Ian A Martinez Flores |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356821649 PECOS PAC ID: 0345593844 Enrollment ID: I20210802002219 |
| Provider Name | Asra Rab |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710414438 PECOS PAC ID: 3577837343 Enrollment ID: I20210811000977 |
| Provider Name | Saba Batool |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285112854 PECOS PAC ID: 6709282437 Enrollment ID: I20210907000086 |
| Provider Name | Zahra Ahmad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902218175 PECOS PAC ID: 6901164185 Enrollment ID: I20210920000141 |
| Provider Name | Bazal Ehsan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497242770 PECOS PAC ID: 0749532760 Enrollment ID: I20211001000863 |
| Provider Name | Amanda Harris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871937326 PECOS PAC ID: 7315237302 Enrollment ID: I20211112001195 |
| Provider Name | Taylor Jordan Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376128439 PECOS PAC ID: 2466845482 Enrollment ID: I20220215000755 |
| Provider Name | Pranitha Kovuri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205489135 PECOS PAC ID: 8022498989 Enrollment ID: I20220708002845 |
| Provider Name | Ahmed Mohamed Agameya |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386199495 PECOS PAC ID: 0345621827 Enrollment ID: I20220714001841 |
| Provider Name | Panagiotis Panagiotakis |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1043241292 PECOS PAC ID: 6002829306 Enrollment ID: I20230725002839 |
Comprehensive Healthcare, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2401 Broadway St, Lower Level, Pekin, IL 61554 Phone: 309-349-3175 Fax: 309-620-8751 | |
Heartland Health Service - Broadway Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 19 Olt Ave, Pekin, IL 61554 Phone: 309-680-7600 Fax: 309-353-3334 | |
Mayclare Iii Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 600 S 13th St, Suite E, Pekin, IL 61554 Phone: 309-353-0473 Fax: 309-347-3148 | |
Home Visiting Physician Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1021 Court Street, Suite B, Pekin, IL 61554 Phone: 309-267-2034 Fax: 309-402-0180 | |
Innovative Medical Therapies Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2355 Broadway St, Suite B, Pekin, IL 61554 Phone: 309-347-2700 | |
Planned Parenthood Of Illinois Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 328 S 4th Street, Pekin, IL 61554 Phone: 309-347-1274 Fax: 309-347-6283 | |
Miller Family Medicine, Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1503 Valle Vista Blvd, Pekin, IL 61554 Phone: 309-840-2177 |