| Prairie Cardiovascular Consultants, Ltd. | |
|
619 E Mason St Ste 4p57 Springfield IL 62701-1034 | |
| (217) 788-0706 | |
| (217) 788-0848 |
| Full Name | Prairie Cardiovascular Consultants, Ltd. |
|---|---|
| Speciality | Clinic/Center |
| Location | 619 E Mason St Ste 4p57, Springfield, Illinois |
| Authorized Official Name and Position | Andrew Watson (CFO) |
| Authorized Official Contact | 2177880706 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Cardiovascular Consultants, Ltd. 619 E Mason St Ste 4p57 Springfield IL 62701-1034 Ph: (217) 788-0706 | Prairie Cardiovascular Consultants, Ltd. 619 E Mason St Ste 4p57 Springfield IL 62701-1034 Ph: (217) 788-0706 |
| NPI Number | 1982714218 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 08/17/2022 |
| Medicare PECOS PAC ID | 3173435880 |
|---|---|
| Medicare Enrollment ID | O20031103000090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982714218 | NPI | - | NPPES |
| CC1312 | Other | IL | RAILROAD MEDICARE |
| CA3360 | Other | IL | RAILROAD MEDICARE |
| CI5907 | Other | IL | RAILROAD MEDICARE |
| CA6852 | Other | IL | RAILROAD MEDICARE |
| CE0750 | Other | IL | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Jeffrey A Goldstein |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1689756900 PECOS PAC ID: 9739088675 Enrollment ID: I20040108000676 |
| Provider Name | John D Sadoff |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1619973765 PECOS PAC ID: 1456252907 Enrollment ID: I20040301000184 |
| Provider Name | Nasaraiah Nallamothu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1427130426 PECOS PAC ID: 8022905017 Enrollment ID: I20040303000926 |
| Provider Name | Nabil M Alsharif |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1730108804 PECOS PAC ID: 5890684724 Enrollment ID: I20040312000415 |
| Provider Name | Patrick B Murphy |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1497703367 PECOS PAC ID: 5395721674 Enrollment ID: I20040628000292 |
| Provider Name | Christopher H Gram |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1528040219 PECOS PAC ID: 3375520844 Enrollment ID: I20040701001435 |
| Provider Name | Neil J Thomas |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1720070238 PECOS PAC ID: 8729047659 Enrollment ID: I20041006001345 |
| Provider Name | Krishna J Rocha Singh |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1508948530 PECOS PAC ID: 5092778241 Enrollment ID: I20041109000039 |
| Provider Name | Manohar Kola |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1982786273 PECOS PAC ID: 0648234740 Enrollment ID: I20041118000234 |
| Provider Name | Erbert Caceres |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1508976788 PECOS PAC ID: 3274582754 Enrollment ID: I20050121000825 |
| Provider Name | Jeffrey D Trachtenberg |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1821070517 PECOS PAC ID: 8921047325 Enrollment ID: I20050426000579 |
| Provider Name | Varadendra B Panchamukhi |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1447332457 PECOS PAC ID: 5799725974 Enrollment ID: I20050506000306 |
| Provider Name | Michael G Jakoby |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1770515181 PECOS PAC ID: 3577504422 Enrollment ID: I20050520000277 |
| Provider Name | Cesar E Coello |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1003997560 PECOS PAC ID: 5698716488 Enrollment ID: I20050523000328 |
| Provider Name | Mansura S Ghani |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1639253701 PECOS PAC ID: 3375570757 Enrollment ID: I20050719000179 |
| Provider Name | Mark S Steen |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1306929906 PECOS PAC ID: 8426086984 Enrollment ID: I20050727000506 |
| Provider Name | Ziad F Issa |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1740362094 PECOS PAC ID: 0648201020 Enrollment ID: I20050825000375 |
| Provider Name | Richard E Katholi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1245312529 PECOS PAC ID: 1355376658 Enrollment ID: I20051005000234 |
| Provider Name | Dacia Renee Gerst |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104874338 PECOS PAC ID: 5799700878 Enrollment ID: I20051007000382 |
| Provider Name | Madhu R Dukkipati |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1063436715 PECOS PAC ID: 1658398037 Enrollment ID: I20051025000628 |
| Provider Name | Gabor Matos |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1639251747 PECOS PAC ID: 2860419934 Enrollment ID: I20051027000970 |
| Provider Name | Thomas Cahill |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1023128113 PECOS PAC ID: 0143241703 Enrollment ID: I20051209000672 |
| Provider Name | Jennifer K Black |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174607576 PECOS PAC ID: 2163444894 Enrollment ID: I20051222000251 |
| Provider Name | Bassam Al Joundi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1144277534 PECOS PAC ID: 0648264606 Enrollment ID: I20060608000047 |
| Provider Name | Lori Beth Helmers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063457794 PECOS PAC ID: 3173536067 Enrollment ID: I20060718000361 |
| Provider Name | Daniel Earl Cox |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1205862117 PECOS PAC ID: 0143233999 Enrollment ID: I20060720000132 |
| Provider Name | Theodore R Addai |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1912985185 PECOS PAC ID: 7810991338 Enrollment ID: I20060914000039 |
| Provider Name | Raed Al-dallow |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1164572095 PECOS PAC ID: 4688675903 Enrollment ID: I20070129000474 |
| Provider Name | Atul Sharad Shah |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1215965660 PECOS PAC ID: 2860471950 Enrollment ID: I20070524000259 |
| Provider Name | John B Gill |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1487737177 PECOS PAC ID: 9032139555 Enrollment ID: I20070619000153 |
| Provider Name | Regina Y Chiu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1043272693 PECOS PAC ID: 8224032586 Enrollment ID: I20070829000328 |
| Provider Name | Dana M Loepker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225295967 PECOS PAC ID: 4789755083 Enrollment ID: I20080613000260 |
| Provider Name | Brian D Miller |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1972685014 PECOS PAC ID: 8921172313 Enrollment ID: I20080802000047 |
| Provider Name | Nancy K Chatham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922249895 PECOS PAC ID: 9133279508 Enrollment ID: I20090608000053 |
| Provider Name | Shiyam K Satwani |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1407067184 PECOS PAC ID: 3870681919 Enrollment ID: I20091014000521 |
| Provider Name | Gretchen L Mahaney Caldwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265763163 PECOS PAC ID: 4183750243 Enrollment ID: I20100327000422 |
| Provider Name | Allison B Campos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962731919 PECOS PAC ID: 9133256209 Enrollment ID: I20100421000443 |
| Provider Name | Angela K Lafrenz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326378175 PECOS PAC ID: 7719016872 Enrollment ID: I20100527000562 |
| Provider Name | Luis J Caceres |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1942381496 PECOS PAC ID: 0840316097 Enrollment ID: I20100925000144 |
| Provider Name | Roop Lal |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1124059506 PECOS PAC ID: 9931188026 Enrollment ID: I20101105001285 |
| Provider Name | Jill R Schindler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447568761 PECOS PAC ID: 7911195789 Enrollment ID: I20101221000115 |
| Provider Name | Susan Elizabeth Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588974026 PECOS PAC ID: 1052500980 Enrollment ID: I20110107000696 |
| Provider Name | Pamela M Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881701308 PECOS PAC ID: 4587603824 Enrollment ID: I20110309000975 |
| Provider Name | Venkatesh Anjan |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1275799850 PECOS PAC ID: 3678751484 Enrollment ID: I20110627000446 |
| Provider Name | John P Scally |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1508952318 PECOS PAC ID: 8527238161 Enrollment ID: I20110927000548 |
| Provider Name | Justin W Kierbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841579026 PECOS PAC ID: 1153593728 Enrollment ID: I20111004000791 |
| Provider Name | Jeanne Marie Kairouz |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1003846908 PECOS PAC ID: 3274523204 Enrollment ID: I20111208000631 |
| Provider Name | George Berberian |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1962569046 PECOS PAC ID: 7214016658 Enrollment ID: I20120308000836 |
| Provider Name | Pavan Kumar Gupta |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1861519563 PECOS PAC ID: 2264525526 Enrollment ID: I20121009000432 |
| Provider Name | Amit S Dande |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1477735298 PECOS PAC ID: 1355580218 Enrollment ID: I20130625000742 |
| Provider Name | Daniel D Correa De Sa |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1548383748 PECOS PAC ID: 4789759168 Enrollment ID: I20130730000106 |
| Provider Name | Paban Saha |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1275698144 PECOS PAC ID: 7113141797 Enrollment ID: I20140623000891 |
| Provider Name | Avinash M Murthy |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1528228624 PECOS PAC ID: 9335364181 Enrollment ID: I20140710001715 |
| Provider Name | Sheri D Barnett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871995472 PECOS PAC ID: 9335361138 Enrollment ID: I20141111002082 |
| Provider Name | Aman Khurana |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073568259 PECOS PAC ID: 9537180633 Enrollment ID: I20141113000685 |
| Provider Name | Meredith M Fleming |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215333604 PECOS PAC ID: 5294058368 Enrollment ID: I20141222000244 |
| Provider Name | Jessica J Prange |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1306089024 PECOS PAC ID: 6507177094 Enrollment ID: I20150625000022 |
| Provider Name | Scott Marrus |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1063578284 PECOS PAC ID: 1254507346 Enrollment ID: I20151201000695 |
| Provider Name | Shauna B Vogler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487011144 PECOS PAC ID: 7113221201 Enrollment ID: I20160210001619 |
| Provider Name | Vikas Kalra |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1023270550 PECOS PAC ID: 0143516138 Enrollment ID: I20160830002424 |
| Provider Name | Hillary D Danenberger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073965570 PECOS PAC ID: 4587950506 Enrollment ID: I20160831000274 |
| Provider Name | Katherine A Corbin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710433768 PECOS PAC ID: 1052699790 Enrollment ID: I20161031001535 |
| Provider Name | Melissa K Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679920052 PECOS PAC ID: 6406135656 Enrollment ID: I20170201000169 |
| Provider Name | Kellsey R Thole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407397862 PECOS PAC ID: 4880970375 Enrollment ID: I20170418001352 |
| Provider Name | Martha L Cline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831637040 PECOS PAC ID: 3476821521 Enrollment ID: I20170614002438 |
| Provider Name | Kamel Sadat |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1013189281 PECOS PAC ID: 4880710706 Enrollment ID: I20170801003441 |
| Provider Name | Andrea Nicole Bloodworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588187397 PECOS PAC ID: 2062778368 Enrollment ID: I20171101003099 |
| Provider Name | Amber N Ridgeway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649786906 PECOS PAC ID: 9931469111 Enrollment ID: I20180208000045 |
| Provider Name | Tu Cao |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316238736 PECOS PAC ID: 1850651936 Enrollment ID: I20180209001570 |
| Provider Name | Mohammad Al-akchar |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1730561903 PECOS PAC ID: 4284980467 Enrollment ID: I20180629002224 |
| Provider Name | Michael Jason Hushion |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1578887063 PECOS PAC ID: 6406158757 Enrollment ID: I20180710001179 |
| Provider Name | Yifei Sun |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1477840833 PECOS PAC ID: 7416259890 Enrollment ID: I20180719000455 |
| Provider Name | Dana A Baugher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497268965 PECOS PAC ID: 7214273804 Enrollment ID: I20190118001983 |
| Provider Name | Emily A Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760940712 PECOS PAC ID: 0244572188 Enrollment ID: I20190425001407 |
| Provider Name | Bharath Rajagopalan |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1700199445 PECOS PAC ID: 1355649302 Enrollment ID: I20190709000553 |
| Provider Name | Christine L Walthes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982247342 PECOS PAC ID: 8921433392 Enrollment ID: I20200113000579 |
| Provider Name | Mohsin Salih |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1326488594 PECOS PAC ID: 3274835020 Enrollment ID: I20200227001123 |
| Provider Name | Masoor Kamalesh |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1689638595 PECOS PAC ID: 8022187772 Enrollment ID: I20200528002185 |
| Provider Name | Arti Singh |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1982969960 PECOS PAC ID: 6507150513 Enrollment ID: I20200608002610 |
| Provider Name | Frederick Otieno Ochieng |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1497072854 PECOS PAC ID: 3476871963 Enrollment ID: I20200824001186 |
| Provider Name | Dylan S Mckinney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811504087 PECOS PAC ID: 3870903206 Enrollment ID: I20201113000482 |
| Provider Name | Dawn K Winebright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285214130 PECOS PAC ID: 8820499890 Enrollment ID: I20210628002880 |
| Provider Name | Vinaya C Mulkareddy |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1104207984 PECOS PAC ID: 6608180583 Enrollment ID: I20210721000650 |
| Provider Name | Rex Rizaldo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053022202 PECOS PAC ID: 1557732963 Enrollment ID: I20230123002080 |
| Provider Name | Abdur Rahman Ahmad |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1053727776 PECOS PAC ID: 2961751714 Enrollment ID: I20230302002813 |
| Provider Name | Christopher H May |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1699942482 PECOS PAC ID: 2668606229 Enrollment ID: I20230616003322 |
| Provider Name | Elizabeth A Lawler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699473900 PECOS PAC ID: 9931569878 Enrollment ID: I20230725001249 |
| Provider Name | Alexis Stephanie Schubert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497408348 PECOS PAC ID: 5294196911 Enrollment ID: I20230727003207 |
| Provider Name | John Yang |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1093759417 PECOS PAC ID: 5294747549 Enrollment ID: I20230920002672 |
| Provider Name | Basil Abu-el-haija |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1881825594 PECOS PAC ID: 9537383229 Enrollment ID: I20240219002803 |
| Provider Name | Chelsea R. Bell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407230188 PECOS PAC ID: 5890073910 Enrollment ID: I20240228000942 |
| Provider Name | Fadol Mohamed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578090734 PECOS PAC ID: 6406126663 Enrollment ID: I20240318001804 |
| Provider Name | Shelly L Baldwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992321582 PECOS PAC ID: 1456896547 Enrollment ID: I20240712002828 |
| Provider Name | Michael G. Barkett |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831546134 PECOS PAC ID: 1254742133 Enrollment ID: I20240904000922 |
| Provider Name | Samer Ahmad Ali-hasan |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1699869503 PECOS PAC ID: 0446323976 Enrollment ID: I20241010001214 |
Board Of Trustees Of Southern Illinois University Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2833 S Grand Ave E, Springfield, IL 62703 Phone: 221-753-5310 Fax: 217-789-2069 | |
Hshs Medical Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3215 Executive Park Dr, Springfield, IL 62703 Phone: 217-523-5406 | |
Michael Bova M D S C Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2524 Farragut Dr, Suite C, Springfield, IL 62704 Phone: 217-726-9346 | |
North Dirksen Medical Associates, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3220 Atlanta St, Springfield, IL 62707 Phone: 217-588-7400 | |
Siu Physicians & Surgeons, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 N 1st St, D235, Springfield, IL 62781 Phone: 217-545-7578 Fax: 217-545-1884 | |
B3 Healthcare Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 319 E Madison St Ste 2d, Springfield, IL 62701 Phone: 217-508-5859 |