| Pine Ridge Ihs Hospital | |
|
East Highway 18 Pine Ridge SD 57770-9998 | |
| (605) 837-3314 | |
| (605) 867-3332 |
| Full Name | Pine Ridge Ihs Hospital |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | East Highway 18, Pine Ridge, South Dakota |
| Authorized Official Name and Position | Rhonda M Akers (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 6058673032 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Ridge Ihs Hospital Po Box 1201 Pine Ridge SD 57770-1201 Ph: (605) 867-3032 | Pine Ridge Ihs Hospital East Highway 18 Pine Ridge SD 57770-9998 Ph: (605) 837-3314 |
| NPI Number | 1497786412 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 09/24/2021 |
| Medicare PECOS PAC ID | 4688571326 |
|---|---|
| Medicare Enrollment ID | O20031218000966 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497786412 | NPI | - | NPPES |
| HSZ153 | Other | PTAN PART B | |
| AC0018 | Other | ASC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 282N00000X | General Acute Care Hospital | (* (Not Available)) | Primary |
| 341600000X | Ambulance | (* (Not Available)) | Secondary |
| Provider Name | Gwen E Mccormick |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1578516068 PECOS PAC ID: 1153225032 Enrollment ID: I20040224001310 |
| Provider Name | Louis C Raymond |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1760437016 PECOS PAC ID: 5496640732 Enrollment ID: I20040318000862 |
| Provider Name | David E Melville |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245270339 PECOS PAC ID: 5395726558 Enrollment ID: I20040525001216 |
| Provider Name | Carol A Kiesling |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912075847 PECOS PAC ID: 4688656739 Enrollment ID: I20040603000201 |
| Provider Name | Mila Berdecia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972549970 PECOS PAC ID: 4981684206 Enrollment ID: I20040726000502 |
| Provider Name | Rommel A Brandt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508873712 PECOS PAC ID: 6002886959 Enrollment ID: I20040728000687 |
| Provider Name | Kevin B Stacks |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679596423 PECOS PAC ID: 1153384193 Enrollment ID: I20041111000752 |
| Provider Name | Charles D Knife Chief |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1760405740 PECOS PAC ID: 9638134240 Enrollment ID: I20041123000567 |
| Provider Name | Ayodele O Ogunremi |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1205884137 PECOS PAC ID: 1153311311 Enrollment ID: I20050301000816 |
| Provider Name | Scott W Smith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629041991 PECOS PAC ID: 1456265149 Enrollment ID: I20050315001114 |
| Provider Name | Monte S. Dirks |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1760462642 PECOS PAC ID: 2466434550 Enrollment ID: I20050324001214 |
| Provider Name | Timothy T Mccay |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1245221761 PECOS PAC ID: 2961456538 Enrollment ID: I20050621000935 |
| Provider Name | Dean Roy Fullingim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770574253 PECOS PAC ID: 5193710929 Enrollment ID: I20050712000568 |
| Provider Name | Sheila Malone Taber |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447241971 PECOS PAC ID: 1557311495 Enrollment ID: I20050715000344 |
| Provider Name | George E Erbacher |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326039801 PECOS PAC ID: 5991755829 Enrollment ID: I20050720000214 |
| Provider Name | Felino A Pascual |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801877055 PECOS PAC ID: 6002801834 Enrollment ID: I20050728000628 |
| Provider Name | John S Dennis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871584060 PECOS PAC ID: 3173594389 Enrollment ID: I20050728000739 |
| Provider Name | Anuma K. Ulu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982731741 PECOS PAC ID: 4486679057 Enrollment ID: I20051012000829 |
| Provider Name | Todd Smith |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1912973603 PECOS PAC ID: 6406872548 Enrollment ID: I20051018001206 |
| Provider Name | Elwyn A. Garaza |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1790868818 PECOS PAC ID: 9234167867 Enrollment ID: I20051219000351 |
| Provider Name | Brenda M Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578539599 PECOS PAC ID: 7618999087 Enrollment ID: I20051228000779 |
| Provider Name | Robert C Burgess |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1013961978 PECOS PAC ID: 5890702146 Enrollment ID: I20060608000332 |
| Provider Name | John D Walton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326096850 PECOS PAC ID: 3375546054 Enrollment ID: I20060907000113 |
| Provider Name | Myeong S Yoon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497722342 PECOS PAC ID: 0042227266 Enrollment ID: I20070219000272 |
| Provider Name | David Wong |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447305594 PECOS PAC ID: 0446358154 Enrollment ID: I20070604000591 |
| Provider Name | Katherine Brooks |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891895256 PECOS PAC ID: 8921098302 Enrollment ID: I20080212000638 |
| Provider Name | Andrew S Qualm |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1881669661 PECOS PAC ID: 6709962418 Enrollment ID: I20080320000509 |
| Provider Name | Gay E Nord |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1144263815 PECOS PAC ID: 6002993417 Enrollment ID: I20080409000753 |
| Provider Name | Amanda M Youngers |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1568625531 PECOS PAC ID: 4587731856 Enrollment ID: I20080929000388 |
| Provider Name | Gianluca Cerri |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922157627 PECOS PAC ID: 5395642193 Enrollment ID: I20081001000148 |
| Provider Name | Amber N Janis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598920738 PECOS PAC ID: 0941378087 Enrollment ID: I20081002000542 |
| Provider Name | Laura L Arrowsmith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083654800 PECOS PAC ID: 9638123631 Enrollment ID: I20081014000674 |
| Provider Name | Judith Wolfstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013914456 PECOS PAC ID: 0345135232 Enrollment ID: I20081203000298 |
| Provider Name | Sharon K Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023269552 PECOS PAC ID: 1254494545 Enrollment ID: I20090113000499 |
| Provider Name | Hector I Burgos |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1609852490 PECOS PAC ID: 8628133386 Enrollment ID: I20090211000821 |
| Provider Name | Jason Pack |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861549743 PECOS PAC ID: 3375623887 Enrollment ID: I20090305000362 |
| Provider Name | Ralph Noah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669458741 PECOS PAC ID: 6800966284 Enrollment ID: I20090326000463 |
| Provider Name | Robert W King |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760495477 PECOS PAC ID: 2961399712 Enrollment ID: I20090520000243 |
| Provider Name | Hooby P Yoon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508066473 PECOS PAC ID: 4486705779 Enrollment ID: I20090626000135 |
| Provider Name | William L Herold |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326187055 PECOS PAC ID: 6305883075 Enrollment ID: I20090708000653 |
| Provider Name | Syed Ahmed Naseeruddin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760599575 PECOS PAC ID: 4981754017 Enrollment ID: I20090709000468 |
| Provider Name | Kelly Cole |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699958157 PECOS PAC ID: 0648322024 Enrollment ID: I20090916000496 |
| Provider Name | Jeremy Scott Fullingim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255537304 PECOS PAC ID: 5092867762 Enrollment ID: I20090917000124 |
| Provider Name | Damon L Brooks |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558583963 PECOS PAC ID: 4587715354 Enrollment ID: I20090917000269 |
| Provider Name | David P Dipaolo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376532820 PECOS PAC ID: 0042359994 Enrollment ID: I20091205000202 |
| Provider Name | Michelle M Ponder |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447399415 PECOS PAC ID: 4880787217 Enrollment ID: I20100428000166 |
| Provider Name | James Murtagh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760655526 PECOS PAC ID: 5991859456 Enrollment ID: I20100614000198 |
| Provider Name | Arthur A Scotson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790017168 PECOS PAC ID: 4486786431 Enrollment ID: I20100709000744 |
| Provider Name | Christos Vassiliou |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053567784 PECOS PAC ID: 8820120454 Enrollment ID: I20100719000117 |
| Provider Name | Neil J Murphy |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1598878019 PECOS PAC ID: 4082738638 Enrollment ID: I20100902000903 |
| Provider Name | Frederick Kronen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093758617 PECOS PAC ID: 0244278737 Enrollment ID: I20100914000888 |
| Provider Name | Patrick D Lynch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205842903 PECOS PAC ID: 7214823731 Enrollment ID: I20101012000861 |
| Provider Name | Steven G Beliel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891767703 PECOS PAC ID: 5092908632 Enrollment ID: I20101015000144 |
| Provider Name | Char M Murff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114156429 PECOS PAC ID: 3476680208 Enrollment ID: I20110316000088 |
| Provider Name | Matthew J Cazan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861479453 PECOS PAC ID: 8022290824 Enrollment ID: I20110316000238 |
| Provider Name | Nina C Jones |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003877754 PECOS PAC ID: 6901833367 Enrollment ID: I20110414000371 |
| Provider Name | Donald E Conklin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285613323 PECOS PAC ID: 9032133657 Enrollment ID: I20110608000834 |
| Provider Name | Richard Urbina |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306057732 PECOS PAC ID: 1759414386 Enrollment ID: I20110815000915 |
| Provider Name | Stephen A Back |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639302060 PECOS PAC ID: 3476723594 Enrollment ID: I20110829000547 |
| Provider Name | Leigh A Havens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437477163 PECOS PAC ID: 8022149426 Enrollment ID: I20111011000647 |
| Provider Name | Ann W Giganti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922174424 PECOS PAC ID: 8729263660 Enrollment ID: I20111129000675 |
| Provider Name | Gary S Kots |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1205112893 PECOS PAC ID: 8022284025 Enrollment ID: I20111221000627 |
| Provider Name | Jay D Stearns |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578759734 PECOS PAC ID: 5496843716 Enrollment ID: I20120201000222 |
| Provider Name | Elizabeth C Graham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003183252 PECOS PAC ID: 1456512557 Enrollment ID: I20120417000726 |
| Provider Name | Amad Zineldine |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417910167 PECOS PAC ID: 4587673272 Enrollment ID: I20120423000691 |
| Provider Name | Michael Yuz |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1710972617 PECOS PAC ID: 6507756822 Enrollment ID: I20120508000361 |
| Provider Name | David A Yost |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225044399 PECOS PAC ID: 2860469871 Enrollment ID: I20120508000545 |
| Provider Name | Theresa L Rodzevik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972826436 PECOS PAC ID: 8628230794 Enrollment ID: I20120612000146 |
| Provider Name | Patrick B O Hayre |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518134352 PECOS PAC ID: 2264695402 Enrollment ID: I20120730000568 |
| Provider Name | Leila Danielle See |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013164268 PECOS PAC ID: 6800059064 Enrollment ID: I20120810000291 |
| Provider Name | Michael A Kalinosky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770551269 PECOS PAC ID: 4183717374 Enrollment ID: I20120816000831 |
| Provider Name | Jeffrey W Shelton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194864074 PECOS PAC ID: 7719141639 Enrollment ID: I20120823000396 |
| Provider Name | Nicholas A Davila |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629324678 PECOS PAC ID: 8123277548 Enrollment ID: I20120928000473 |
| Provider Name | Jose Rodriguez |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1467425926 PECOS PAC ID: 7719132570 Enrollment ID: I20130227000375 |
| Provider Name | Michelle L Pino |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1992864896 PECOS PAC ID: 1254491848 Enrollment ID: I20130424000230 |
| Provider Name | Joshua M Timock |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841386240 PECOS PAC ID: 6901807478 Enrollment ID: I20130502000278 |
| Provider Name | Bruce Randolph Tizes |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588942379 PECOS PAC ID: 2163661281 Enrollment ID: I20130621000439 |
| Provider Name | Thomas E Menzel |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1417948225 PECOS PAC ID: 4880780865 Enrollment ID: I20130703000413 |
| Provider Name | Bruce D Bialor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861503492 PECOS PAC ID: 0446201511 Enrollment ID: I20130718000087 |
| Provider Name | Nenette R Mcnamara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154655835 PECOS PAC ID: 0244378784 Enrollment ID: I20130718000306 |
| Provider Name | Jonathon D Kirkland |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639315260 PECOS PAC ID: 4789823139 Enrollment ID: I20130726000027 |
| Provider Name | Prafull Chandra Gandhi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841391042 PECOS PAC ID: 6507921459 Enrollment ID: I20130814000328 |
| Provider Name | Sidney Todd Mitchell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518027630 PECOS PAC ID: 2466407614 Enrollment ID: I20130814000479 |
| Provider Name | James N Pham |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306089578 PECOS PAC ID: 4284876558 Enrollment ID: I20130911000061 |
| Provider Name | Ramya Srinivasan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912100611 PECOS PAC ID: 4587750658 Enrollment ID: I20130916000477 |
| Provider Name | Cheryl D Scaff |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1801231345 PECOS PAC ID: 4981848470 Enrollment ID: I20130924000418 |
| Provider Name | Kinan Hawasly |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1295062347 PECOS PAC ID: 7416181029 Enrollment ID: I20131015001570 |
| Provider Name | Catherine B Mascari |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1124016449 PECOS PAC ID: 7517922784 Enrollment ID: I20131024000895 |
| Provider Name | Kenneth A Freeman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750714754 PECOS PAC ID: 4284861220 Enrollment ID: I20131218001028 |
| Provider Name | Marylou Karambizi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528491131 PECOS PAC ID: 4880821867 Enrollment ID: I20131219000445 |
| Provider Name | Deidra C Zorn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821421728 PECOS PAC ID: 1052548948 Enrollment ID: I20131223000256 |
| Provider Name | Jeffrey A Yablong |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467479287 PECOS PAC ID: 6800797002 Enrollment ID: I20140123001154 |
| Provider Name | Jerl D Stewart |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1689815110 PECOS PAC ID: 2062560758 Enrollment ID: I20140204001143 |
| Provider Name | Jonathan Michael Wildy |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1619137288 PECOS PAC ID: 3971777384 Enrollment ID: I20140206001369 |
| Provider Name | Kamaleldin H Kamal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396837795 PECOS PAC ID: 9032215058 Enrollment ID: I20140215000078 |
| Provider Name | Donald Eugene Brown |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1346236148 PECOS PAC ID: 1052303583 Enrollment ID: I20140221000540 |
| Provider Name | Adam M Borah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831173350 PECOS PAC ID: 3779716287 Enrollment ID: I20140508000933 |
| Provider Name | Toikus Westbrook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285738468 PECOS PAC ID: 1153348362 Enrollment ID: I20140514001053 |
| Provider Name | Brooke White |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558679035 PECOS PAC ID: 4688807464 Enrollment ID: I20140516000548 |
| Provider Name | Anthony Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194037770 PECOS PAC ID: 5597938233 Enrollment ID: I20140602000346 |
| Provider Name | James E Rohan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144290347 PECOS PAC ID: 5991779852 Enrollment ID: I20140630001429 |
| Provider Name | Michael J Golden |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952527012 PECOS PAC ID: 9032353313 Enrollment ID: I20140701000579 |
| Provider Name | Sherry Lynn Speer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649365842 PECOS PAC ID: 8426086513 Enrollment ID: I20140723000226 |
| Provider Name | Evelyn Gonzalez Del Rio |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1144367103 PECOS PAC ID: 5890912430 Enrollment ID: I20140806000056 |
| Provider Name | Jamil Ibrahim |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245222587 PECOS PAC ID: 2769518471 Enrollment ID: I20140807000852 |
| Provider Name | Nicholas Bull |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487968756 PECOS PAC ID: 6507099389 Enrollment ID: I20140821001827 |
| Provider Name | John Allen Clarke Houston |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1184956161 PECOS PAC ID: 0749423366 Enrollment ID: I20140826002799 |
| Provider Name | Peter J Mostert |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326346875 PECOS PAC ID: 2860635844 Enrollment ID: I20140828001578 |
| Provider Name | Deema Ismail |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548403793 PECOS PAC ID: 9638325384 Enrollment ID: I20140829000157 |
| Provider Name | Stephen D Lindenbaum |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1033174479 PECOS PAC ID: 2668377920 Enrollment ID: I20140912001963 |
| Provider Name | Catherine D Friesen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356338966 PECOS PAC ID: 0941217459 Enrollment ID: I20140917000679 |
| Provider Name | Jacqueline M Pierce |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1730296039 PECOS PAC ID: 1951576297 Enrollment ID: I20140924001154 |
| Provider Name | Bo Yon Choi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053551721 PECOS PAC ID: 5890920870 Enrollment ID: I20140925002205 |
| Provider Name | Catherine M O'brien |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1871830125 PECOS PAC ID: 7113148438 Enrollment ID: I20141029001703 |
| Provider Name | Gabriele Knierim |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366420499 PECOS PAC ID: 7012957004 Enrollment ID: I20141112000939 |
| Provider Name | Arthur L Webb |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1861438137 PECOS PAC ID: 0840272357 Enrollment ID: I20141113000496 |
| Provider Name | Joselyn Agosto-betancourt |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1740519073 PECOS PAC ID: 2567784614 Enrollment ID: I20141201001570 |
| Provider Name | Tracy Fluty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578826111 PECOS PAC ID: 9133385818 Enrollment ID: I20141212000450 |
| Provider Name | Lance Mcadams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497089205 PECOS PAC ID: 5991028730 Enrollment ID: I20141230002145 |
| Provider Name | Robert L Hunter |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871688101 PECOS PAC ID: 1456409119 Enrollment ID: I20150109001259 |
| Provider Name | Manola K Sanixay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447314166 PECOS PAC ID: 0244126282 Enrollment ID: I20150114001259 |
| Provider Name | David J Ingle |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700884491 PECOS PAC ID: 4688561368 Enrollment ID: I20150116001899 |
| Provider Name | Leanna M Brooks Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407847726 PECOS PAC ID: 6204917917 Enrollment ID: I20150209000244 |
| Provider Name | Nelson Sanabria Hilerio |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679560460 PECOS PAC ID: 8628092715 Enrollment ID: I20150209001389 |
| Provider Name | Dorothy Sue Jennings |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609807551 PECOS PAC ID: 2466430327 Enrollment ID: I20150226001776 |
| Provider Name | Katherine Mackenzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063674554 PECOS PAC ID: 5698825032 Enrollment ID: I20150227000158 |
| Provider Name | Geoffrey Michael Giordano |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699081042 PECOS PAC ID: 7618141029 Enrollment ID: I20150317000233 |
| Provider Name | Mark L Harlow |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1144209818 PECOS PAC ID: 3476446576 Enrollment ID: I20150406000658 |
| Provider Name | Michael Ryan Johnson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1336419969 PECOS PAC ID: 1557522687 Enrollment ID: I20150420001664 |
| Provider Name | Latania C Sci |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033266937 PECOS PAC ID: 8224124359 Enrollment ID: I20150421002271 |
| Provider Name | Juli D Finch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932364759 PECOS PAC ID: 4486973963 Enrollment ID: I20150505001222 |
| Provider Name | Carol Kugel Freeman |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1538242375 PECOS PAC ID: 4486617693 Enrollment ID: I20150528002082 |
| Provider Name | Tony Underwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558759530 PECOS PAC ID: 5496076440 Enrollment ID: I20150603001162 |
| Provider Name | Kyle G Flowers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063710580 PECOS PAC ID: 2769703107 Enrollment ID: I20150610001387 |
| Provider Name | Tanakorn Songrug |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073847455 PECOS PAC ID: 7416184478 Enrollment ID: I20150615002064 |
| Provider Name | Donald Von Borstel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275887663 PECOS PAC ID: 3779894860 Enrollment ID: I20150617001059 |
| Provider Name | Albert Matos Guadalupe |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1053354738 PECOS PAC ID: 7517139629 Enrollment ID: I20150630002513 |
| Provider Name | Kira M Mantell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447492632 PECOS PAC ID: 0941468565 Enrollment ID: I20150721001112 |
| Provider Name | Elizabeth Y Park |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063771004 PECOS PAC ID: 4486967213 Enrollment ID: I20150722004346 |
| Provider Name | Cheri P Sweet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710202239 PECOS PAC ID: 1456481894 Enrollment ID: I20150804003754 |
| Provider Name | Stephanie A Easton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083964928 PECOS PAC ID: 5890930044 Enrollment ID: I20150817000838 |
| Provider Name | Nnamdi K Nwaohiri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467615120 PECOS PAC ID: 5597915801 Enrollment ID: I20150820011461 |
| Provider Name | Ted C Hanf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114221330 PECOS PAC ID: 8022324136 Enrollment ID: I20150904000293 |
| Provider Name | Deborah L Woolley |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1689864308 PECOS PAC ID: 8729094982 Enrollment ID: I20150904002210 |
| Provider Name | Marcus Brown |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275776965 PECOS PAC ID: 8224250816 Enrollment ID: I20150910000185 |
| Provider Name | Marion E Rudek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013275734 PECOS PAC ID: 6305153065 Enrollment ID: I20150914002344 |
| Provider Name | Nancy J L 'heureux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003282708 PECOS PAC ID: 4587972880 Enrollment ID: I20151029001069 |
| Provider Name | Karla Abbott Norris Parkes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114996956 PECOS PAC ID: 8426099185 Enrollment ID: I20151103002401 |
| Provider Name | Katy M Maker |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1861423014 PECOS PAC ID: 3274623954 Enrollment ID: I20151112002436 |
| Provider Name | James H Barnebee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184791493 PECOS PAC ID: 1658516562 Enrollment ID: I20151116002188 |
| Provider Name | Graciela B Reyes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326471202 PECOS PAC ID: 7012137839 Enrollment ID: I20151207002979 |
| Provider Name | Natalie A Wipert |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1265775290 PECOS PAC ID: 1951537091 Enrollment ID: I20151216002672 |
| Provider Name | Jonathan Orton |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1932335338 PECOS PAC ID: 1658599261 Enrollment ID: I20151217000468 |
| Provider Name | Allison B Taranto |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1699171009 PECOS PAC ID: 7618277336 Enrollment ID: I20151217001214 |
| Provider Name | Dawn Underwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083002729 PECOS PAC ID: 3072814748 Enrollment ID: I20151222002182 |
| Provider Name | Perry D Guthrie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477939882 PECOS PAC ID: 1254634850 Enrollment ID: I20160114000824 |
| Provider Name | Ann H Thedieck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073569745 PECOS PAC ID: 4789650730 Enrollment ID: I20160126000441 |
| Provider Name | Russell Stagg |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1720356496 PECOS PAC ID: 2961663489 Enrollment ID: I20160129000484 |
| Provider Name | John J Shufeldt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114955440 PECOS PAC ID: 9638083215 Enrollment ID: I20160212001096 |
| Provider Name | Marsha K Fearing |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023007184 PECOS PAC ID: 0143257493 Enrollment ID: I20160224002956 |
| Provider Name | Kristen A Hodsdon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821007600 PECOS PAC ID: 5294875621 Enrollment ID: I20160302002192 |
| Provider Name | Antonio Monson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659456259 PECOS PAC ID: 5698937886 Enrollment ID: I20160308000975 |
| Provider Name | Laurie J Brucia |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1063661973 PECOS PAC ID: 2668540964 Enrollment ID: I20160407000810 |
| Provider Name | Ronald W Schmitz |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1770501892 PECOS PAC ID: 6507857646 Enrollment ID: I20160412000100 |
| Provider Name | Roberto J Carcamo-sanabria |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841308616 PECOS PAC ID: 1355327255 Enrollment ID: I20160420000765 |
| Provider Name | Marco A Godoy Lopez |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396723144 PECOS PAC ID: 3971578477 Enrollment ID: I20160505000484 |
| Provider Name | Wesley A Ellison |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1740391044 PECOS PAC ID: 7416978333 Enrollment ID: I20160518001814 |
| Provider Name | Lawanda Pulley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750743308 PECOS PAC ID: 3779872346 Enrollment ID: I20160520001459 |
| Provider Name | Sara J Jumping Eagle |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508865007 PECOS PAC ID: 7113950049 Enrollment ID: I20160531001602 |
| Provider Name | Jose Maria Borrego Acosta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598807216 PECOS PAC ID: 0143384784 Enrollment ID: I20160601002554 |
| Provider Name | Julie A O'neil |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1295884732 PECOS PAC ID: 5991931529 Enrollment ID: I20160615001154 |
| Provider Name | George Polanco |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326019332 PECOS PAC ID: 0244210755 Enrollment ID: I20160713002114 |
| Provider Name | Jacob W Read |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245696392 PECOS PAC ID: 8426352063 Enrollment ID: I20160721001942 |
| Provider Name | James P Olson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1649219601 PECOS PAC ID: 6901842848 Enrollment ID: I20160725002616 |
| Provider Name | Vernon E Zurick |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174556567 PECOS PAC ID: 5991738742 Enrollment ID: I20160822001102 |
| Provider Name | Daniel G Bercu |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710926456 PECOS PAC ID: 5496746802 Enrollment ID: I20160824000324 |
| Provider Name | Shannon K Wolfinbarger |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1235591413 PECOS PAC ID: 0648565887 Enrollment ID: I20160826000286 |
| Provider Name | Hyo J Kim |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588738314 PECOS PAC ID: 6608939707 Enrollment ID: I20160827000338 |
| Provider Name | Michael E Rush |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053367656 PECOS PAC ID: 7618959123 Enrollment ID: I20160829000885 |
| Provider Name | Carol A Narkevic |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467726778 PECOS PAC ID: 4981867165 Enrollment ID: I20160914002593 |
| Provider Name | Mauricio A Consalter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083653927 PECOS PAC ID: 4082691472 Enrollment ID: I20160927000110 |
| Provider Name | Brant E Kirk |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1477843605 PECOS PAC ID: 0749578912 Enrollment ID: I20161004002562 |
| Provider Name | Timian M Godfrey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316353923 PECOS PAC ID: 2668794629 Enrollment ID: I20161011001300 |
| Provider Name | Cyrus C Doe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053765560 PECOS PAC ID: 7719265537 Enrollment ID: I20161031000587 |
| Provider Name | Aamer Farooki |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316941859 PECOS PAC ID: 5698768539 Enrollment ID: I20161108000164 |
| Provider Name | Jean Cunningham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467824995 PECOS PAC ID: 3870872005 Enrollment ID: I20161111000070 |
| Provider Name | Carl G Lindquist |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073565255 PECOS PAC ID: 6305996315 Enrollment ID: I20161111000206 |
| Provider Name | Richard J Herzig |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1922078443 PECOS PAC ID: 6507854882 Enrollment ID: I20161115000111 |
| Provider Name | Sally A Reichert |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1487769717 PECOS PAC ID: 0941196661 Enrollment ID: I20161115001663 |
| Provider Name | Ronald A Stillerman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1679549166 PECOS PAC ID: 7214958370 Enrollment ID: I20161122000168 |
| Provider Name | Simone Hills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730540881 PECOS PAC ID: 1254610850 Enrollment ID: I20161123000942 |
| Provider Name | Arelis Benitez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1275635500 PECOS PAC ID: 0648424333 Enrollment ID: I20161215000039 |
| Provider Name | Deborah Jerard |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649291360 PECOS PAC ID: 5890939482 Enrollment ID: I20170103000227 |
| Provider Name | Mary Kathryn Bowen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1497911838 PECOS PAC ID: 7315109139 Enrollment ID: I20170208002438 |
| Provider Name | Bart M Rowlett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104945526 PECOS PAC ID: 5092602102 Enrollment ID: I20170215002368 |
| Provider Name | Jonathan S Reisman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770804015 PECOS PAC ID: 9537326731 Enrollment ID: I20170303000831 |
| Provider Name | Sindhura Alapati |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528370319 PECOS PAC ID: 7012220189 Enrollment ID: I20170315001813 |
| Provider Name | Emad Hamid |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457553588 PECOS PAC ID: 7618021999 Enrollment ID: I20170502001404 |
| Provider Name | Thomas Reif |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174678494 PECOS PAC ID: 0547220881 Enrollment ID: I20170504002043 |
| Provider Name | Suzanne M England |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1750358354 PECOS PAC ID: 6103974027 Enrollment ID: I20170506000002 |
| Provider Name | Lucas S Van Oeveren |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1740487172 PECOS PAC ID: 8022132778 Enrollment ID: I20170512001964 |
| Provider Name | Matthew R Nipe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467735753 PECOS PAC ID: 6901026533 Enrollment ID: I20170515001340 |
| Provider Name | Brian S Skow |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922083831 PECOS PAC ID: 5799699930 Enrollment ID: I20170516000623 |
| Provider Name | Kelly A Rhone |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467463877 PECOS PAC ID: 0446212575 Enrollment ID: I20170516002660 |
| Provider Name | Katie A Dejong |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376838730 PECOS PAC ID: 5991946352 Enrollment ID: I20170518000581 |
| Provider Name | Collin W Vaughn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104933068 PECOS PAC ID: 4183760770 Enrollment ID: I20170518001346 |
| Provider Name | Garrett Ross Taylor |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1861409252 PECOS PAC ID: 5698964252 Enrollment ID: I20170518001788 |
| Provider Name | Vernon D Smith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730166737 PECOS PAC ID: 3971646316 Enrollment ID: I20170519000098 |
| Provider Name | Kenneth E Mann |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851398713 PECOS PAC ID: 7113985441 Enrollment ID: I20170519000382 |
| Provider Name | Heeyoung Paul Wang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700173317 PECOS PAC ID: 9931327111 Enrollment ID: I20170519000478 |
| Provider Name | Benjamin J Shives |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871812602 PECOS PAC ID: 9335377357 Enrollment ID: I20170519000845 |
| Provider Name | John M Travnicek |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174556609 PECOS PAC ID: 1759386626 Enrollment ID: I20170519001278 |
| Provider Name | Nicole L Stethem |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841204286 PECOS PAC ID: 0042242703 Enrollment ID: I20170524000313 |
| Provider Name | Adam Boice Foster |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811230311 PECOS PAC ID: 6406123504 Enrollment ID: I20170526000322 |
| Provider Name | John C Haughey |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679739288 PECOS PAC ID: 6204967169 Enrollment ID: I20170624000105 |
| Provider Name | Avery L. Sides |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629360342 PECOS PAC ID: 4688894017 Enrollment ID: I20170624000172 |
| Provider Name | Blake Edward Weaver |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497785893 PECOS PAC ID: 6103890975 Enrollment ID: I20170629001468 |
| Provider Name | Charles H Kornblau |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356585780 PECOS PAC ID: 2668515677 Enrollment ID: I20170920003732 |
| Provider Name | Patrick J Fullerton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811039555 PECOS PAC ID: 2668371857 Enrollment ID: I20170920003815 |
| Provider Name | Jose R Pesquera Garcia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598788408 PECOS PAC ID: 4981500584 Enrollment ID: I20170921003242 |
| Provider Name | Rachel Taylor |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770923179 PECOS PAC ID: 3274807656 Enrollment ID: I20170923000231 |
| Provider Name | Timothy Bilash |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437189545 PECOS PAC ID: 6709838162 Enrollment ID: I20170928003320 |
| Provider Name | Kevin L Hamm |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578657623 PECOS PAC ID: 8022919620 Enrollment ID: I20171014000017 |
| Provider Name | Maryann Fanning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225449226 PECOS PAC ID: 2163643198 Enrollment ID: I20171115001546 |
| Provider Name | Ali Saleem |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639448020 PECOS PAC ID: 1759501562 Enrollment ID: I20171207001100 |
| Provider Name | Ramona T Coppelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235199498 PECOS PAC ID: 1355476532 Enrollment ID: I20171214000010 |
| Provider Name | Lara L Phillips |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609160993 PECOS PAC ID: 2466675863 Enrollment ID: I20180131002689 |
| Provider Name | Renee J Christ |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1023161585 PECOS PAC ID: 3274432182 Enrollment ID: I20180202000878 |
| Provider Name | Susan Hendren |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1629593165 PECOS PAC ID: 2466712864 Enrollment ID: I20180202001634 |
| Provider Name | Surinder A Pal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538245139 PECOS PAC ID: 5294987624 Enrollment ID: I20180205001168 |
| Provider Name | Kiran B Khanolkar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902809536 PECOS PAC ID: 8628163664 Enrollment ID: I20180206001017 |
| Provider Name | Tonya M Grissam |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1043385131 PECOS PAC ID: 8022376938 Enrollment ID: I20180209000345 |
| Provider Name | Elizabeth Bush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538215520 PECOS PAC ID: 8426048646 Enrollment ID: I20180216001192 |
| Provider Name | Laura Elizabeth Romcevich |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912249665 PECOS PAC ID: 9931336229 Enrollment ID: I20180306000560 |
| Provider Name | Joyce C Chukwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356879852 PECOS PAC ID: 9133481989 Enrollment ID: I20180315000673 |
| Provider Name | Jamie Ramsey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881057305 PECOS PAC ID: 0143519546 Enrollment ID: I20180319001837 |
| Provider Name | Vivian Lee Thorsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295910024 PECOS PAC ID: 5092873497 Enrollment ID: I20180409000889 |
| Provider Name | Amina Asrar Ahmed |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1174685556 PECOS PAC ID: 8628220548 Enrollment ID: I20180531000259 |
| Provider Name | Teresa R Conroy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720317886 PECOS PAC ID: 4486919776 Enrollment ID: I20180608000245 |
| Provider Name | Julia D Knarreborg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952662363 PECOS PAC ID: 3173828803 Enrollment ID: I20180703001304 |
| Provider Name | Laura M Young |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720048267 PECOS PAC ID: 9436109477 Enrollment ID: I20180813001041 |
| Provider Name | Robert N Jarman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992765390 PECOS PAC ID: 1052372968 Enrollment ID: I20180815000762 |
| Provider Name | Alfred C Degner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891755294 PECOS PAC ID: 4082675996 Enrollment ID: I20180822000860 |
| Provider Name | Frantz Saint-vil |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588866610 PECOS PAC ID: 1254635741 Enrollment ID: I20180911001674 |
| Provider Name | Steven Matthew Wright |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366733404 PECOS PAC ID: 0042536575 Enrollment ID: I20180912003056 |
| Provider Name | Mark Krich |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144238767 PECOS PAC ID: 4789585985 Enrollment ID: I20180924000921 |
| Provider Name | Kyle F Summers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346663135 PECOS PAC ID: 6406119593 Enrollment ID: I20180926000466 |
| Provider Name | Johanna M Missak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508170663 PECOS PAC ID: 7214167626 Enrollment ID: I20181009001485 |
| Provider Name | Christopher Q May |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073847695 PECOS PAC ID: 6204951544 Enrollment ID: I20181016000608 |
| Provider Name | Ronald Stephen Pritchard |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1417998774 PECOS PAC ID: 2668426578 Enrollment ID: I20181016001073 |
| Provider Name | Linda Marchionna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255880415 PECOS PAC ID: 8729352620 Enrollment ID: I20181023000344 |
| Provider Name | Shawn D Grant |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043214497 PECOS PAC ID: 6204877079 Enrollment ID: I20181211000646 |
| Provider Name | Jim L Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548713258 PECOS PAC ID: 9032407424 Enrollment ID: I20181214002814 |
| Provider Name | Michael C Christopher |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205933744 PECOS PAC ID: 1052212164 Enrollment ID: I20190108003025 |
| Provider Name | Irene C Murema |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1063839983 PECOS PAC ID: 9234432824 Enrollment ID: I20190109000788 |
| Provider Name | John Rutter |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1891709549 PECOS PAC ID: 9638171515 Enrollment ID: I20190111002205 |
| Provider Name | Chelsea Lynn Iversen |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1326595554 PECOS PAC ID: 4981940582 Enrollment ID: I20190117002003 |
| Provider Name | Kari L Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285894006 PECOS PAC ID: 7719223379 Enrollment ID: I20190118000741 |
| Provider Name | Alice P Wright |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043252984 PECOS PAC ID: 9638175243 Enrollment ID: I20190118001287 |
| Provider Name | Jeffrey A Joseph |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346256427 PECOS PAC ID: 8022001742 Enrollment ID: I20190123003168 |
| Provider Name | Sarah M Perlman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164704169 PECOS PAC ID: 7618149683 Enrollment ID: I20190402002339 |
| Provider Name | Tenecia Dawn Lancaster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972049401 PECOS PAC ID: 7012294408 Enrollment ID: I20190409000091 |
| Provider Name | Daniel Edward Rice |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1639454333 PECOS PAC ID: 2860774130 Enrollment ID: I20190517000871 |
| Provider Name | Jason W Sylte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922475789 PECOS PAC ID: 8820390230 Enrollment ID: I20190523000171 |
| Provider Name | Amina Dafalla |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1497194864 PECOS PAC ID: 0446519805 Enrollment ID: I20190604000721 |
| Provider Name | Silas Willoughby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649782814 PECOS PAC ID: 9436327418 Enrollment ID: I20190604001209 |
| Provider Name | Rachel A Ritter |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1720429301 PECOS PAC ID: 2961630538 Enrollment ID: I20190610001632 |
| Provider Name | Conleth Crotser |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1215901616 PECOS PAC ID: 3274421706 Enrollment ID: I20190617000259 |
| Provider Name | Konni K Kluender |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982046363 PECOS PAC ID: 8224263272 Enrollment ID: I20190617001530 |
| Provider Name | Kelly Lueck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578815809 PECOS PAC ID: 3779728043 Enrollment ID: I20190709000634 |
| Provider Name | Bernadette Kucinski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275063331 PECOS PAC ID: 4385970888 Enrollment ID: I20190722001732 |
| Provider Name | Steven O Kidd |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730138090 PECOS PAC ID: 6608102751 Enrollment ID: I20190726000483 |
| Provider Name | Patti A Hacker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114368669 PECOS PAC ID: 7416284062 Enrollment ID: I20190806001131 |
| Provider Name | Marie L Duan Meservy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699018424 PECOS PAC ID: 0749588374 Enrollment ID: I20190830002587 |
| Provider Name | Gerald R Gosnell |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1144262536 PECOS PAC ID: 4385744317 Enrollment ID: I20190909003485 |
| Provider Name | Jean Junior |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710340344 PECOS PAC ID: 7012277833 Enrollment ID: I20190912000780 |
| Provider Name | Jacqueline L Young Cooper |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1275706608 PECOS PAC ID: 0648324202 Enrollment ID: I20190923000111 |
| Provider Name | Eugenio Erquiaga |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528005048 PECOS PAC ID: 6002947033 Enrollment ID: I20190923000256 |
| Provider Name | Joyce N Achenjang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750736096 PECOS PAC ID: 6709174675 Enrollment ID: I20191010002215 |
| Provider Name | Lyndon D Taylor |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1003924127 PECOS PAC ID: 6901857127 Enrollment ID: I20191014000573 |
| Provider Name | Dalton E Latham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194291179 PECOS PAC ID: 5991037061 Enrollment ID: I20191023002325 |
| Provider Name | Peter C Glassbrenner |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1811335391 PECOS PAC ID: 4385885078 Enrollment ID: I20191023003475 |
| Provider Name | Julie A Freeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225683915 PECOS PAC ID: 4385976224 Enrollment ID: I20191028000294 |
| Provider Name | Robert A Grover |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1649299546 PECOS PAC ID: 9739171059 Enrollment ID: I20191028001064 |
| Provider Name | Main Y Quan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194097147 PECOS PAC ID: 8022328558 Enrollment ID: I20191104002184 |
| Provider Name | Shannon M Shields |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598118358 PECOS PAC ID: 5799064291 Enrollment ID: I20191105001192 |
| Provider Name | Nicholas A Strle |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851703185 PECOS PAC ID: 4587999354 Enrollment ID: I20191115001941 |
| Provider Name | Cathleen Distor |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1275646853 PECOS PAC ID: 0143227512 Enrollment ID: I20191120001439 |
| Provider Name | Susanne R Owens |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1811259955 PECOS PAC ID: 0345564613 Enrollment ID: I20191217001036 |
| Provider Name | Erick Stuart French |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649206806 PECOS PAC ID: 5799722492 Enrollment ID: I20200103000310 |
| Provider Name | Ming T Lin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427088947 PECOS PAC ID: 9133186125 Enrollment ID: I20200124000272 |
| Provider Name | Steven T Parrish |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487655361 PECOS PAC ID: 8729009808 Enrollment ID: I20200204000858 |
| Provider Name | Sara M Mcintosh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861940249 PECOS PAC ID: 6507153723 Enrollment ID: I20200210002006 |
| Provider Name | Stephen Frausto |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1811105117 PECOS PAC ID: 6507965035 Enrollment ID: I20200226001947 |
| Provider Name | Jeff Lee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073933289 PECOS PAC ID: 2567899552 Enrollment ID: I20200304001706 |
| Provider Name | Kenneth J Ransom |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1376635193 PECOS PAC ID: 3870530405 Enrollment ID: I20200310001144 |
| Provider Name | Mark E Kellam |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356346449 PECOS PAC ID: 7719951177 Enrollment ID: I20200316000583 |
| Provider Name | Florence J Iyoha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326553462 PECOS PAC ID: 8325477268 Enrollment ID: I20200329000525 |
| Provider Name | Matthew Stillion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841657798 PECOS PAC ID: 0840620407 Enrollment ID: I20200422001125 |
| Provider Name | Joanna J Sampson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386111474 PECOS PAC ID: 5395174916 Enrollment ID: I20200429000252 |
| Provider Name | Carol Lea Wright Becker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437440609 PECOS PAC ID: 9638482458 Enrollment ID: I20200520000604 |
| Provider Name | Nathaniel Gregg Denicola |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1225205651 PECOS PAC ID: 3779752860 Enrollment ID: I20200528000518 |
| Provider Name | Mckinley C Lawson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104137181 PECOS PAC ID: 6103056759 Enrollment ID: I20200609000592 |
| Provider Name | Nabil A Yassa |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467438911 PECOS PAC ID: 8729020839 Enrollment ID: I20200609000648 |
| Provider Name | David Kings Oginni |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1467807149 PECOS PAC ID: 1052733862 Enrollment ID: I20200624002628 |
| Provider Name | Scott D Kassing |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588672141 PECOS PAC ID: 4183675820 Enrollment ID: I20200629000354 |
| Provider Name | Christopher D Roman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033266838 PECOS PAC ID: 1850482761 Enrollment ID: I20200701000532 |
| Provider Name | Megan Algeo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629459003 PECOS PAC ID: 4284920034 Enrollment ID: I20200805001130 |
| Provider Name | Samuel Grodman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912394800 PECOS PAC ID: 4385957984 Enrollment ID: I20200806001719 |
| Provider Name | Neil A Goodloe |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1376589317 PECOS PAC ID: 6305840794 Enrollment ID: I20200818000023 |
| Provider Name | Kaleigh Krebs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104478627 PECOS PAC ID: 5698005437 Enrollment ID: I20200908001148 |
| Provider Name | George R Drew |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639223605 PECOS PAC ID: 2769370477 Enrollment ID: I20200930001344 |
| Provider Name | Vikram S Shankar |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821443276 PECOS PAC ID: 5294154894 Enrollment ID: I20201001000468 |
| Provider Name | Socrates P Maroudis |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1073792651 PECOS PAC ID: 5698828168 Enrollment ID: I20201006000103 |
| Provider Name | Chad F Simmons |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1316105653 PECOS PAC ID: 3971654997 Enrollment ID: I20201117000594 |
| Provider Name | Carl T Mickman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124445242 PECOS PAC ID: 8729333133 Enrollment ID: I20201117001983 |
| Provider Name | Samantha M Blevins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972061307 PECOS PAC ID: 0345582177 Enrollment ID: I20201124000569 |
| Provider Name | Harshal Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932562931 PECOS PAC ID: 9739472978 Enrollment ID: I20201214001257 |
| Provider Name | Naushaba Hasan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942298559 PECOS PAC ID: 1456359306 Enrollment ID: I20210121002204 |
| Provider Name | Frank Stackhouse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164551255 PECOS PAC ID: 7911023247 Enrollment ID: I20210127002190 |
| Provider Name | Brittany J Dixon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992191803 PECOS PAC ID: 9436490505 Enrollment ID: I20210129000531 |
| Provider Name | Aaron M Brody |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811209539 PECOS PAC ID: 0547401762 Enrollment ID: I20210208001729 |
| Provider Name | Elizabeth L Hatz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467705640 PECOS PAC ID: 3173836475 Enrollment ID: I20210211000968 |
| Provider Name | Andrew J Modic |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063831972 PECOS PAC ID: 4688993322 Enrollment ID: I20210212000128 |
| Provider Name | Igor Shumskiy |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1801214044 PECOS PAC ID: 4486873502 Enrollment ID: I20210318000672 |
| Provider Name | Johanna C Hewitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235726753 PECOS PAC ID: 1456768308 Enrollment ID: I20210322001396 |
| Provider Name | Renea Reano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558960153 PECOS PAC ID: 5991113631 Enrollment ID: I20210420000289 |
| Provider Name | Mary T Chapman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467078162 PECOS PAC ID: 9638587082 Enrollment ID: I20210423000222 |
| Provider Name | Meredith E Haskins |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881011740 PECOS PAC ID: 8820395205 Enrollment ID: I20210428001538 |
| Provider Name | Cynthia R Houtrouw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952753626 PECOS PAC ID: 0143508333 Enrollment ID: I20210610000509 |
| Provider Name | Matthew Bledsoe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295116721 PECOS PAC ID: 6608188024 Enrollment ID: I20210702000599 |
| Provider Name | Rafel Alvarez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1215383005 PECOS PAC ID: 7618247586 Enrollment ID: I20210706000944 |
| Provider Name | Tyler Braaten |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134507957 PECOS PAC ID: 3577964352 Enrollment ID: I20210708000016 |
| Provider Name | Susan J Walden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376041426 PECOS PAC ID: 2062764830 Enrollment ID: I20210802001632 |
| Provider Name | Rachel E Wilson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508353178 PECOS PAC ID: 4789939372 Enrollment ID: I20210803000155 |
| Provider Name | Baruch Berzon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750692356 PECOS PAC ID: 7911139142 Enrollment ID: I20210804000742 |
| Provider Name | Joseph Liberal Giramata |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831666197 PECOS PAC ID: 5890033864 Enrollment ID: I20210804000960 |
| Provider Name | Christopher Michael Greenland |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083107460 PECOS PAC ID: 2567715295 Enrollment ID: I20210809002954 |
| Provider Name | Chantel L Schmidt |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1588233076 PECOS PAC ID: 9133524911 Enrollment ID: I20210817000958 |
| Provider Name | Marco Anshien |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962994970 PECOS PAC ID: 0547515439 Enrollment ID: I20210818003752 |
| Provider Name | Lori J Barnes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598820284 PECOS PAC ID: 5496989394 Enrollment ID: I20210823001653 |
| Provider Name | Vinay Maudar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235270224 PECOS PAC ID: 2860419058 Enrollment ID: I20210916001609 |
| Provider Name | Zean Chen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871090670 PECOS PAC ID: 1052717592 Enrollment ID: I20210916002460 |
| Provider Name | Bradley R Parke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124516620 PECOS PAC ID: 4486905593 Enrollment ID: I20210920000182 |
| Provider Name | Alejandro Leon-sanchez |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1598236812 PECOS PAC ID: 4880933803 Enrollment ID: I20210923001473 |
| Provider Name | Igor R Krivitskiy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366947095 PECOS PAC ID: 6507263878 Enrollment ID: I20210929002036 |
| Provider Name | Enock N Nyamoti |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1467842898 PECOS PAC ID: 8325323033 Enrollment ID: I20211019003055 |
| Provider Name | Laura B Cortines |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1700077740 PECOS PAC ID: 1355236845 Enrollment ID: I20211104000467 |
| Provider Name | Sarah E Fredriksson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1093720898 PECOS PAC ID: 3779474705 Enrollment ID: I20220113001369 |
| Provider Name | Dirk Bahoravitch |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1184083826 PECOS PAC ID: 0941595441 Enrollment ID: I20220113001879 |
| Provider Name | Amaya Basta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457589699 PECOS PAC ID: 0042434524 Enrollment ID: I20220118001954 |
| Provider Name | Jordan E Hitchens |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659807006 PECOS PAC ID: 4688075708 Enrollment ID: I20220222000865 |
| Provider Name | Sarah Leeper |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699035162 PECOS PAC ID: 6709101066 Enrollment ID: I20220222001906 |
| Provider Name | Paxon J Riding |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1518349430 PECOS PAC ID: 0941551899 Enrollment ID: I20220321000520 |
| Provider Name | Dustin W Cheney |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225492606 PECOS PAC ID: 9133523418 Enrollment ID: I20220324000946 |
| Provider Name | Oriana Cruz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043794969 PECOS PAC ID: 4789925371 Enrollment ID: I20220413002140 |
| Provider Name | Denise D Viola |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1639349996 PECOS PAC ID: 0648359463 Enrollment ID: I20220429000101 |
| Provider Name | Kyle Tanner Barfield |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255835476 PECOS PAC ID: 6507101011 Enrollment ID: I20220525002078 |
| Provider Name | Tonya Denise Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285034629 PECOS PAC ID: 0244452829 Enrollment ID: I20220614000101 |
| Provider Name | Rika N Omalley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003024365 PECOS PAC ID: 7315011509 Enrollment ID: I20220628001365 |
| Provider Name | James L Kuhn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1033775176 PECOS PAC ID: 2769864388 Enrollment ID: I20220728003648 |
| Provider Name | Anna M Lee |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1447782107 PECOS PAC ID: 6507132693 Enrollment ID: I20220729001260 |
| Provider Name | Martin J Pontasch |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053408872 PECOS PAC ID: 1456334325 Enrollment ID: I20220802001929 |
| Provider Name | Michael D Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215956768 PECOS PAC ID: 3971674862 Enrollment ID: I20220805001710 |
| Provider Name | Amy A Pittman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972567600 PECOS PAC ID: 8628013380 Enrollment ID: I20220906000729 |
| Provider Name | Joan E Lanier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568663540 PECOS PAC ID: 4082633904 Enrollment ID: I20220912002667 |
| Provider Name | Colleen L Campbell-lane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750523395 PECOS PAC ID: 7618006743 Enrollment ID: I20220921001068 |
| Provider Name | Brian W Newman |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1649631193 PECOS PAC ID: 6406154681 Enrollment ID: I20221013003607 |
| Provider Name | Madison Bangert |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235666918 PECOS PAC ID: 8123409745 Enrollment ID: I20221102000981 |
| Provider Name | Jennifer Risse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821582990 PECOS PAC ID: 4183964109 Enrollment ID: I20221102002353 |
| Provider Name | William Bernard Rozzi |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1114032083 PECOS PAC ID: 8921009440 Enrollment ID: I20221130001024 |
| Provider Name | Gary R Wakeman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891776696 PECOS PAC ID: 4880677897 Enrollment ID: I20221130003193 |
| Provider Name | Kimberly E Matz Gugliotto |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144601196 PECOS PAC ID: 4385928845 Enrollment ID: I20221130003637 |
| Provider Name | Kelly W Ryder |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083866651 PECOS PAC ID: 7719038512 Enrollment ID: I20221206002474 |
| Provider Name | Sachin Moonat |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669867529 PECOS PAC ID: 8325359763 Enrollment ID: I20221212000671 |
| Provider Name | Christine D Manns |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932516705 PECOS PAC ID: 3173993748 Enrollment ID: I20221227000219 |
| Provider Name | Courtney Ebert Hein |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1790243558 PECOS PAC ID: 4385015338 Enrollment ID: I20230130001768 |
| Provider Name | Arthur F Wang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548498751 PECOS PAC ID: 0244496966 Enrollment ID: I20230215000885 |
| Provider Name | Augustine Y Alifo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114926375 PECOS PAC ID: 8729077151 Enrollment ID: I20230309001047 |
| Provider Name | Yoldez A Meroueh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578096723 PECOS PAC ID: 7315298569 Enrollment ID: I20230314000287 |
| Provider Name | Paul M Castle |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265095236 PECOS PAC ID: 2163757550 Enrollment ID: I20230320000376 |
| Provider Name | Raymond F Zurcher |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972530145 PECOS PAC ID: 1658374103 Enrollment ID: I20230330001290 |
| Provider Name | Diana A Lenis |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1316409907 PECOS PAC ID: 6002142700 Enrollment ID: I20230405001102 |
| Provider Name | Monay D Wadsworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912589441 PECOS PAC ID: 1153796636 Enrollment ID: I20230414001618 |
| Provider Name | Jaime H Bohlman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1124161740 PECOS PAC ID: 5698870905 Enrollment ID: I20230530001212 |
| Provider Name | Kathleen L Shaffer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912940834 PECOS PAC ID: 7012011265 Enrollment ID: I20230530002881 |
| Provider Name | Natalie Tymkowych |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942509252 PECOS PAC ID: 0941420772 Enrollment ID: I20230629002403 |
| Provider Name | Rebecca Catherine Gerrity |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598228918 PECOS PAC ID: 8123351251 Enrollment ID: I20230816000098 |
| Provider Name | Deborah J Gross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649305087 PECOS PAC ID: 1557328788 Enrollment ID: I20230821003472 |
| Provider Name | Donald C Spoon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013381391 PECOS PAC ID: 4082910062 Enrollment ID: I20230822001362 |
| Provider Name | Annabel L Bradford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215324694 PECOS PAC ID: 1355655572 Enrollment ID: I20231008000114 |
| Provider Name | Matthew D Streckert |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902983034 PECOS PAC ID: 8022181510 Enrollment ID: I20231218001873 |
| Provider Name | Lauren D Hinkle |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1184194011 PECOS PAC ID: 7517206733 Enrollment ID: I20231218003095 |
| Provider Name | Emma G Cortes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528553674 PECOS PAC ID: 5890140081 Enrollment ID: I20231219003287 |
| Provider Name | David M Crawford |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427258896 PECOS PAC ID: 8426190604 Enrollment ID: I20240208001318 |
| Provider Name | Candace Norwood Wilson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1275791188 PECOS PAC ID: 8426205428 Enrollment ID: I20240212001516 |
| Provider Name | Mark J Ptacek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083611958 PECOS PAC ID: 5395654545 Enrollment ID: I20240212001806 |
| Provider Name | Samantha Tarshis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104273630 PECOS PAC ID: 7012201171 Enrollment ID: I20240227003576 |
| Provider Name | Renee Friend |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134476062 PECOS PAC ID: 7810343274 Enrollment ID: I20240311001382 |
| Provider Name | Stephanie M Mitchell |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1033652714 PECOS PAC ID: 6406137082 Enrollment ID: I20240506000223 |
Pine Ridge Indian Health Service Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: East Highway 18, Pine Ridge, SD 57701 Phone: 605-867-3032 | |
Oglala Sioux Tribe Continuum Of Care Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1588 Us-18, Pine Ridge, SD 57770 Phone: 214-738-8707 Fax: 866-781-9370 |