| Radial Health Southeast Llc | |
|
2045 Fountain Professional Ct Ste A Navarre FL 32566-5108 | |
| (850) 494-3212 | |
| Not Available |
| Full Name | Radial Health Southeast Llc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 2045 Fountain Professional Ct Ste A, Navarre, Florida |
| Authorized Official Name and Position | Amish Patel (PRESIDENT) |
| Authorized Official Contact | 8167283674 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radial Health Southeast Llc 2500 W Higgins Rd Ste 1165 Hoffman Estates IL 60169-2050 Ph: (678) 234-2992 | Radial Health Southeast Llc 2045 Fountain Professional Ct Ste A Navarre FL 32566-5108 Ph: (850) 494-3212 |
| NPI Number | 1174159891 |
|---|---|
| Provider Enumeration Date | 03/13/2020 |
| Last Update Date | 11/04/2024 |
| Medicare PECOS PAC ID | 7113357476 |
|---|---|
| Medicare Enrollment ID | O20200429000224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174159891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Diane Zhao |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1033143151 PECOS PAC ID: 5890761191 Enrollment ID: I20040909000305 |
| Provider Name | Rosa Tam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043298458 PECOS PAC ID: 5991769234 Enrollment ID: I20041116000712 |
| Provider Name | Christine J Weot |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1760449094 PECOS PAC ID: 0648211748 Enrollment ID: I20050520000031 |
| Provider Name | Constantino Luis Regalado |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134110521 PECOS PAC ID: 1951345966 Enrollment ID: I20050610000430 |
| Provider Name | Elias N Amador |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326039702 PECOS PAC ID: 3678504610 Enrollment ID: I20050830000028 |
| Provider Name | Edwidge L Raoul |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1417089160 PECOS PAC ID: 4688697741 Enrollment ID: I20060104000725 |
| Provider Name | Rafael A Santiago |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1366480543 PECOS PAC ID: 0042393597 Enrollment ID: I20080207000279 |
| Provider Name | Rodolfo V Guevara |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437368552 PECOS PAC ID: 2668547662 Enrollment ID: I20080826000130 |
| Provider Name | Christopher Eugene Burton |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1033320718 PECOS PAC ID: 7113089251 Enrollment ID: I20081223000614 |
| Provider Name | Francisco J Molina |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295935120 PECOS PAC ID: 7911043005 Enrollment ID: I20091002000288 |
| Provider Name | Stephen Slobodian |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1386627347 PECOS PAC ID: 8921148867 Enrollment ID: I20091228000167 |
| Provider Name | Raul J Roa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316110653 PECOS PAC ID: 0143364448 Enrollment ID: I20100224000989 |
| Provider Name | Emin Hodzic |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861795049 PECOS PAC ID: 1052580156 Enrollment ID: I20110805000692 |
| Provider Name | Sheryce M Andrews |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1053538942 PECOS PAC ID: 5890969638 Enrollment ID: I20111114000422 |
| Provider Name | Pamela Weiker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063843118 PECOS PAC ID: 4587893177 Enrollment ID: I20140130001186 |
| Provider Name | John Mcmaster Wyatt |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1659313724 PECOS PAC ID: 5991699316 Enrollment ID: I20140923002558 |
| Provider Name | Sergio Hernandez Borges |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043600414 PECOS PAC ID: 7012203458 Enrollment ID: I20161119000046 |
| Provider Name | Alfredo Davila-rivera |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1477713303 PECOS PAC ID: 8022160340 Enrollment ID: I20161229000690 |
| Provider Name | Collynne A Tyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548715089 PECOS PAC ID: 5597048710 Enrollment ID: I20170214002448 |
| Provider Name | Matthew Tyler Knowlton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619476645 PECOS PAC ID: 0446512420 Enrollment ID: I20180403002114 |
| Provider Name | Bernard R Beaupin |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1528225083 PECOS PAC ID: 4284708215 Enrollment ID: I20190124002499 |
| Provider Name | Mark Felix Roldan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104308329 PECOS PAC ID: 1850639121 Enrollment ID: I20190212000831 |
| Provider Name | Judene P Harrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932600699 PECOS PAC ID: 5496093288 Enrollment ID: I20190221001271 |
| Provider Name | Stacy Ann Jordan |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1700266608 PECOS PAC ID: 1456680115 Enrollment ID: I20190906000586 |
| Provider Name | Mary C Scoigletti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891884169 PECOS PAC ID: 5597722603 Enrollment ID: I20190906001329 |
| Provider Name | Nancy Austin Franklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528693983 PECOS PAC ID: 8527480672 Enrollment ID: I20200619000017 |
| Provider Name | Vladimir Slutsker |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1215027362 PECOS PAC ID: 1658264882 Enrollment ID: I20200804002437 |
| Provider Name | Charles Alan Cantrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801317219 PECOS PAC ID: 1759708746 Enrollment ID: I20200908000728 |
| Provider Name | Suzanne Haines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619398633 PECOS PAC ID: 3577792027 Enrollment ID: I20201023001902 |
| Provider Name | My-hanh Thi Inman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649895715 PECOS PAC ID: 2567875230 Enrollment ID: I20210120000096 |
| Provider Name | Stefan G Humphries |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1346249315 PECOS PAC ID: 0446213771 Enrollment ID: I20210316001433 |
| Provider Name | Russell Deutscher |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1750745188 PECOS PAC ID: 7517231434 Enrollment ID: I20210401000106 |
| Provider Name | Tiffany Lau |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1871027946 PECOS PAC ID: 1658642111 Enrollment ID: I20210621003114 |
| Provider Name | Kareen A Velez |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1558565390 PECOS PAC ID: 3971750530 Enrollment ID: I20210817003826 |
| Provider Name | Jenna Louise Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275932287 PECOS PAC ID: 1254552979 Enrollment ID: I20210921003248 |
| Provider Name | Sirinat Blake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295405363 PECOS PAC ID: 7719376060 Enrollment ID: I20211108002884 |
| Provider Name | Lisa K Kurek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134603160 PECOS PAC ID: 6002154804 Enrollment ID: I20211223000054 |
| Provider Name | Yevgeny Zadov |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1356570212 PECOS PAC ID: 7810144862 Enrollment ID: I20220311002218 |
| Provider Name | Wendy S Lundblad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235713124 PECOS PAC ID: 9739576448 Enrollment ID: I20220428000024 |
| Provider Name | Matthew C Gil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801531165 PECOS PAC ID: 3072991231 Enrollment ID: I20220601000564 |
| Provider Name | Christina Ann Blackburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871882084 PECOS PAC ID: 1456731603 Enrollment ID: I20220705003180 |
| Provider Name | Tallat Rizk |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1245237155 PECOS PAC ID: 8729066535 Enrollment ID: I20220722000516 |
| Provider Name | Cindy Crothers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437412004 PECOS PAC ID: 8628294253 Enrollment ID: I20220803002635 |
| Provider Name | Amy Boulton Skonecki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710610852 PECOS PAC ID: 3779966460 Enrollment ID: I20220812001305 |
| Provider Name | Jillian Nicole Ashbolt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740901016 PECOS PAC ID: 0042695967 Enrollment ID: I20220913003672 |
| Provider Name | Brenda Barrows |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891340832 PECOS PAC ID: 4082036488 Enrollment ID: I20221010002801 |
| Provider Name | Carissa Ann Carisse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396368502 PECOS PAC ID: 3274902390 Enrollment ID: I20221213001361 |
| Provider Name | Monica Jemison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043883788 PECOS PAC ID: 1850761826 Enrollment ID: I20230109001032 |
| Provider Name | Supriya Kumar |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1801886205 PECOS PAC ID: 4880641216 Enrollment ID: I20240123004005 |
| Provider Name | Uday Mathur |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1639630312 PECOS PAC ID: 1052654498 Enrollment ID: I20240220001292 |
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