| Saint Joseph Medical Group | |
|
2349 Lake Ave Ste 99 Plymouth IN 46563-7837 | |
| (574) 948-5340 | |
| (574) 948-5494 |
| Full Name | Saint Joseph Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 2349 Lake Ave Ste 99, Plymouth, Indiana |
| Authorized Official Name and Position | Christopher James Karam (PRESIDENT) |
| Authorized Official Contact | 5753352344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Saint Joseph Medical Group 5215 Holy Cross Pkwy Provider Services-enrollment Mishawaka IN 46545-1469 Ph: (574) 335-8707 | Saint Joseph Medical Group 2349 Lake Ave Ste 99 Plymouth IN 46563-7837 Ph: (574) 948-5340 |
| NPI Number | 1225082878 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 10/30/2024 |
| Medicare PECOS PAC ID | 8325950843 |
|---|---|
| Medicare Enrollment ID | O20040708000757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225082878 | NPI | - | NPPES |
| 300041121 | Medicaid | IN | |
| 300045987 | Medicaid | IN | |
| 200091160B | Medicaid | IN | |
| 200162760A | Medicaid | IN | |
| 200162760B | Medicaid | IN | |
| 300026356 | Medicaid | IN | |
| 300038977 | Medicaid | IN | |
| 300045460 | Medicaid | IN | |
| 300047494 | Medicaid | IN | |
| 300055981 | Medicaid | IN | |
| 300041953 | Medicaid | IN | |
| 300000759 | Medicaid | IN | |
| 300035855 | Medicaid | IN | |
| 300048902 | Medicaid | IN | |
| 021236800 | Other | IN | FEDERAL BLACK LUNG |
| 200162760G | Medicaid | IN | |
| 300000756 | Medicaid | IN | |
| 300046029 | Medicaid | IN | |
| CJ6650 | Other | IN | RR MEDICARE |
| 300028778 | Medicaid | IN | |
| 300046084 | Medicaid | IN | |
| 200162760C | Medicaid | IN | |
| 200162760H | Medicaid | IN | |
| 300020807 | Medicaid | IN |
| Provider Name | Paul J Guentert |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1255316782 PECOS PAC ID: 7012821994 Enrollment ID: I20031117000097 |
| Provider Name | Jason K Sprunger |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1306850904 PECOS PAC ID: 9830087253 Enrollment ID: I20040308000982 |
| Provider Name | Michelle L Pearson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841234739 PECOS PAC ID: 3375517477 Enrollment ID: I20040824000968 |
| Provider Name | Frank V Murphy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881696383 PECOS PAC ID: 5294702163 Enrollment ID: I20040911000189 |
| Provider Name | Sachin R Patel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1770587321 PECOS PAC ID: 2961471503 Enrollment ID: I20041002000126 |
| Provider Name | Ashfaq A Turk |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1497750871 PECOS PAC ID: 2860383437 Enrollment ID: I20041002000138 |
| Provider Name | Jason J Ransom |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609846062 PECOS PAC ID: 7315904042 Enrollment ID: I20041214001217 |
| Provider Name | Kandie Ann Forest |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871614594 PECOS PAC ID: 7517925845 Enrollment ID: I20050103000580 |
| Provider Name | Bethany L Mcdaniel-vanderzwaag |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639178650 PECOS PAC ID: 8325090210 Enrollment ID: I20050218000687 |
| Provider Name | Michael A Englert |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801988027 PECOS PAC ID: 5395790695 Enrollment ID: I20050321000464 |
| Provider Name | Rod S Kubley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821037532 PECOS PAC ID: 4486691714 Enrollment ID: I20050408000399 |
| Provider Name | Craig B Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376571265 PECOS PAC ID: 6305883299 Enrollment ID: I20050412001164 |
| Provider Name | Manesh Parikshak |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1356438626 PECOS PAC ID: 7214968148 Enrollment ID: I20050830000688 |
| Provider Name | Marc Gerdisch |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1508822255 PECOS PAC ID: 9638109721 Enrollment ID: I20070323000005 |
| Provider Name | Jennifer Ann Curtis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619048246 PECOS PAC ID: 0840395703 Enrollment ID: I20070420000451 |
| Provider Name | Bryan Foy |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1972569754 PECOS PAC ID: 0547172827 Enrollment ID: I20070703000430 |
| Provider Name | Kevin R Ericson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265458749 PECOS PAC ID: 1759473374 Enrollment ID: I20070827000634 |
| Provider Name | Martin F Wieschhaus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770525198 PECOS PAC ID: 7113019746 Enrollment ID: I20070827000737 |
| Provider Name | Andrew R Barksdale |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1538363247 PECOS PAC ID: 2961597885 Enrollment ID: I20071102000217 |
| Provider Name | John T Taylor |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1891891156 PECOS PAC ID: 0840360129 Enrollment ID: I20080529000147 |
| Provider Name | Adam Eric Perlmutter |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1235270067 PECOS PAC ID: 9032205349 Enrollment ID: I20080812000855 |
| Provider Name | Jason R Grove |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1609040088 PECOS PAC ID: 4183791494 Enrollment ID: I20080927000183 |
| Provider Name | Abdul M Malik |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952300584 PECOS PAC ID: 7315002979 Enrollment ID: I20090213000292 |
| Provider Name | Douglas D Doctor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376598938 PECOS PAC ID: 5597812230 Enrollment ID: I20090415000073 |
| Provider Name | Janet Galanes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235178856 PECOS PAC ID: 4486708930 Enrollment ID: I20090818000329 |
| Provider Name | Meredith K Wierman Schmidt |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1477762680 PECOS PAC ID: 0446347363 Enrollment ID: I20090822000019 |
| Provider Name | John Gregory Aranda |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1316936123 PECOS PAC ID: 2567559412 Enrollment ID: I20091204000205 |
| Provider Name | Robert T Raster |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417924879 PECOS PAC ID: 1850430547 Enrollment ID: I20091210000098 |
| Provider Name | Barbara G Bielska |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1801864251 PECOS PAC ID: 0345383931 Enrollment ID: I20100204000403 |
| Provider Name | Brian L Piazza |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1881703809 PECOS PAC ID: 1850379470 Enrollment ID: I20100304000233 |
| Provider Name | Charles O Higgs Coulthard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447205448 PECOS PAC ID: 3173654142 Enrollment ID: I20100708000743 |
| Provider Name | Tod A Stillson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427003573 PECOS PAC ID: 3476604281 Enrollment ID: I20100726000574 |
| Provider Name | Jennifer Friberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023139821 PECOS PAC ID: 4688707128 Enrollment ID: I20100804000169 |
| Provider Name | Devin D Zimmerman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1760487532 PECOS PAC ID: 7012032659 Enrollment ID: I20100920000250 |
| Provider Name | Paula M Toth-russell |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588756712 PECOS PAC ID: 6901921402 Enrollment ID: I20100921000019 |
| Provider Name | Mark A Muckway |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265521652 PECOS PAC ID: 6305039454 Enrollment ID: I20101021000106 |
| Provider Name | Zubair Ul Haq |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518005198 PECOS PAC ID: 9133313042 Enrollment ID: I20101104000030 |
| Provider Name | Stephen M Simons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881776359 PECOS PAC ID: 5799974184 Enrollment ID: I20110118000091 |
| Provider Name | John F Powell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689618068 PECOS PAC ID: 8527240886 Enrollment ID: I20110308000113 |
| Provider Name | Deidre A Coffey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467747014 PECOS PAC ID: 5890963805 Enrollment ID: I20110719000135 |
| Provider Name | Eric Knapp |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1700090602 PECOS PAC ID: 7315078490 Enrollment ID: I20110801000723 |
| Provider Name | Rachel E Whitcomb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548201684 PECOS PAC ID: 1951572007 Enrollment ID: I20110921000139 |
| Provider Name | Leah Napolitano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023116514 PECOS PAC ID: 1658343157 Enrollment ID: I20120110000737 |
| Provider Name | Bradford Blakeman |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1447212113 PECOS PAC ID: 1355253634 Enrollment ID: I20120112000532 |
| Provider Name | James Tuchek |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1598721250 PECOS PAC ID: 0143250274 Enrollment ID: I20120112000550 |
| Provider Name | Terrence D Wilkin |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1982656963 PECOS PAC ID: 0941228340 Enrollment ID: I20120216000182 |
| Provider Name | Ryan B Greene |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1518171107 PECOS PAC ID: 2062676778 Enrollment ID: I20120608000486 |
| Provider Name | Shamiram B Badal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760629307 PECOS PAC ID: 1557542503 Enrollment ID: I20121026000374 |
| Provider Name | Jessica G Glassman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992054183 PECOS PAC ID: 9032362280 Enrollment ID: I20130122000030 |
| Provider Name | Kimberley K Mendez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043555394 PECOS PAC ID: 7012161946 Enrollment ID: I20130131000189 |
| Provider Name | Can Talug |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1972708535 PECOS PAC ID: 9830243708 Enrollment ID: I20130225000403 |
| Provider Name | David T Wyncott |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194046250 PECOS PAC ID: 4688815483 Enrollment ID: I20130727000057 |
| Provider Name | Zachary Leshen |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1285646729 PECOS PAC ID: 8628139367 Enrollment ID: I20130912000734 |
| Provider Name | David W Parker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1609175777 PECOS PAC ID: 5395970420 Enrollment ID: I20131028000522 |
| Provider Name | Pravin Pratap |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1811105810 PECOS PAC ID: 7113181439 Enrollment ID: I20140116001531 |
| Provider Name | Timothy James Redden |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1194915835 PECOS PAC ID: 9739360652 Enrollment ID: I20140207001623 |
| Provider Name | Anand Singla |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1639207707 PECOS PAC ID: 1355526492 Enrollment ID: I20140812000157 |
| Provider Name | Laura E Blackford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073892428 PECOS PAC ID: 2567686819 Enrollment ID: I20140917003050 |
| Provider Name | Nathaniel Stewart |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063773422 PECOS PAC ID: 3173751534 Enrollment ID: I20141021002161 |
| Provider Name | Tabitha M Pollard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891194981 PECOS PAC ID: 0840412805 Enrollment ID: I20141107000871 |
| Provider Name | Asad U Sheikh |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1376598680 PECOS PAC ID: 4880644152 Enrollment ID: I20141119001569 |
| Provider Name | Abigail M Battjes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336400167 PECOS PAC ID: 2062651011 Enrollment ID: I20141219001029 |
| Provider Name | Christopher C Jordan |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1689938664 PECOS PAC ID: 7012156060 Enrollment ID: I20141231000156 |
| Provider Name | Michele Collins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124382403 PECOS PAC ID: 3173764560 Enrollment ID: I20141231000180 |
| Provider Name | Carol Valdez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376948547 PECOS PAC ID: 8921326943 Enrollment ID: I20150422002416 |
| Provider Name | Jennifer P Heaney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164814760 PECOS PAC ID: 9931428885 Enrollment ID: I20150428000664 |
| Provider Name | Ziad Y Fayad |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1508025867 PECOS PAC ID: 9739321837 Enrollment ID: I20150616001388 |
| Provider Name | Matthew K Folstein |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1952536674 PECOS PAC ID: 8224342944 Enrollment ID: I20150807014766 |
| Provider Name | Kathryn Zehr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144601808 PECOS PAC ID: 8426366386 Enrollment ID: I20150928000277 |
| Provider Name | Joseph J Pulvirenti |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1427044775 PECOS PAC ID: 6103969167 Enrollment ID: I20160106001790 |
| Provider Name | Peter Miller |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1295991081 PECOS PAC ID: 1850537697 Enrollment ID: I20160526001186 |
| Provider Name | Justin M Leugers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679922355 PECOS PAC ID: 7113210568 Enrollment ID: I20160722002353 |
| Provider Name | Benjamin Yourchock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730538414 PECOS PAC ID: 3375836729 Enrollment ID: I20160722002446 |
| Provider Name | Weston S Carter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316385198 PECOS PAC ID: 5597906032 Enrollment ID: I20160801001544 |
| Provider Name | Daniel J Curnyn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407204787 PECOS PAC ID: 8224323068 Enrollment ID: I20160818001175 |
| Provider Name | Anthony J Witt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083063762 PECOS PAC ID: 0648565788 Enrollment ID: I20160829000436 |
| Provider Name | Mark Cabelin |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1386601185 PECOS PAC ID: 3577595701 Enrollment ID: I20161012000737 |
| Provider Name | Anthony V Aspesi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902210560 PECOS PAC ID: 4587889811 Enrollment ID: I20170223001694 |
| Provider Name | Anthony R Gauthier |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1548203540 PECOS PAC ID: 1951313212 Enrollment ID: I20170306000945 |
| Provider Name | Dawn L Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629514799 PECOS PAC ID: 0446536619 Enrollment ID: I20170425000649 |
| Provider Name | Fei Lu |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1841372869 PECOS PAC ID: 5799773776 Enrollment ID: I20170522000730 |
| Provider Name | Yevheniy Shubin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992115273 PECOS PAC ID: 0648542084 Enrollment ID: I20170821001770 |
| Provider Name | Eric James Rindlisbacher |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1689088783 PECOS PAC ID: 5395960587 Enrollment ID: I20170929000585 |
| Provider Name | Neil J Sink |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1659509065 PECOS PAC ID: 3173741949 Enrollment ID: I20171011000323 |
| Provider Name | Glenda D Ensweiler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891043212 PECOS PAC ID: 3971725789 Enrollment ID: I20180118000370 |
| Provider Name | Marie A Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851899140 PECOS PAC ID: 8820351190 Enrollment ID: I20180419000968 |
| Provider Name | Janey Lynne Hardesty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881194751 PECOS PAC ID: 1759645468 Enrollment ID: I20180504001396 |
| Provider Name | Jeffrey Silver |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1770585978 PECOS PAC ID: 0345326153 Enrollment ID: I20180808002132 |
| Provider Name | Scott D Cohen |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1871699652 PECOS PAC ID: 3577475904 Enrollment ID: I20180815003379 |
| Provider Name | Kassem Bourgi |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1780948299 PECOS PAC ID: 8426280983 Enrollment ID: I20180821000750 |
| Provider Name | David A Deboer |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1346242559 PECOS PAC ID: 6305893926 Enrollment ID: I20180910002563 |
| Provider Name | Krystal Kay Lavine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821586207 PECOS PAC ID: 2466705181 Enrollment ID: I20181026001342 |
| Provider Name | Qussai Salamah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447554654 PECOS PAC ID: 5294904462 Enrollment ID: I20181220003361 |
| Provider Name | Mahmud Zamlut |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1952579542 PECOS PAC ID: 4688740384 Enrollment ID: I20190109002457 |
| Provider Name | Marla M Troyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114482676 PECOS PAC ID: 8921348285 Enrollment ID: I20190322001523 |
| Provider Name | Laura Satka Gettler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114499654 PECOS PAC ID: 1658612684 Enrollment ID: I20190401001017 |
| Provider Name | Jeremy L Gunter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285198150 PECOS PAC ID: 0547502775 Enrollment ID: I20190508001605 |
| Provider Name | Donald R Westerhausen |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1437491974 PECOS PAC ID: 4688977515 Enrollment ID: I20190522002386 |
| Provider Name | Anna N Matulewicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184966681 PECOS PAC ID: 3072749449 Enrollment ID: I20190611001203 |
| Provider Name | John Matteucci |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1558456749 PECOS PAC ID: 2961463070 Enrollment ID: I20200424002840 |
| Provider Name | Nicole B Bolinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578195913 PECOS PAC ID: 6103256417 Enrollment ID: I20200428000567 |
| Provider Name | Ruheri Perez Tamayo |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1881655397 PECOS PAC ID: 5092724377 Enrollment ID: I20200430001939 |
| Provider Name | Rachel E Shane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043713688 PECOS PAC ID: 3476984378 Enrollment ID: I20200508001879 |
| Provider Name | Vu Hoang |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1588625677 PECOS PAC ID: 7517152267 Enrollment ID: I20200702000871 |
| Provider Name | Apeksha R Shah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992324883 PECOS PAC ID: 4880018795 Enrollment ID: I20200724002078 |
| Provider Name | Elizabeth Anne Temple |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225281728 PECOS PAC ID: 6204251721 Enrollment ID: I20200730003825 |
| Provider Name | Jeffrey Rosenwinkel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215466222 PECOS PAC ID: 2062782683 Enrollment ID: I20200813000304 |
| Provider Name | David Shafran |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1568480606 PECOS PAC ID: 9830125210 Enrollment ID: I20200826002289 |
| Provider Name | Harsha Nagarajarao |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548471311 PECOS PAC ID: 8022235605 Enrollment ID: I20201009000915 |
| Provider Name | Frank Addo |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1679592828 PECOS PAC ID: 0042215592 Enrollment ID: I20201125001501 |
| Provider Name | Nelson B Isada |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1508925611 PECOS PAC ID: 0244394930 Enrollment ID: I20201204002341 |
| Provider Name | Randall John Bjork |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265434112 PECOS PAC ID: 3678460912 Enrollment ID: I20210415002028 |
| Provider Name | David Johnson |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1467981464 PECOS PAC ID: 6204105158 Enrollment ID: I20210526001066 |
| Provider Name | Morgan Joann Faanes |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1659860096 PECOS PAC ID: 8123373867 Enrollment ID: I20210623001553 |
| Provider Name | Jordan Frances Geroski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265962633 PECOS PAC ID: 1153690037 Enrollment ID: I20210629002571 |
| Provider Name | Zaid Farooq |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1437504768 PECOS PAC ID: 1456645472 Enrollment ID: I20210716000376 |
| Provider Name | Breanna Marie Kartes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538740121 PECOS PAC ID: 2264835438 Enrollment ID: I20210726001846 |
| Provider Name | Lindsey Marie Connolly |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386177830 PECOS PAC ID: 2860730660 Enrollment ID: I20210915003317 |
| Provider Name | Suresh Potluri |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1871757708 PECOS PAC ID: 0244382034 Enrollment ID: I20211006003313 |
| Provider Name | Luis F Gomez |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1538570460 PECOS PAC ID: 8820499742 Enrollment ID: I20211029001728 |
| Provider Name | Anitha Rao |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396989976 PECOS PAC ID: 5193965713 Enrollment ID: I20211130000666 |
| Provider Name | Jasmine Christine Christopher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013421049 PECOS PAC ID: 3971993239 Enrollment ID: I20211201001641 |
| Provider Name | Heather Anne Gordy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417619982 PECOS PAC ID: 3971994112 Enrollment ID: I20211227000408 |
| Provider Name | Kelly E Crowley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730836982 PECOS PAC ID: 4880089259 Enrollment ID: I20220322000720 |
| Provider Name | Anthony Mozer |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1730446915 PECOS PAC ID: 9830498799 Enrollment ID: I20220519000385 |
| Provider Name | Hunter P Nolen |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1619404936 PECOS PAC ID: 8426437534 Enrollment ID: I20220621001547 |
| Provider Name | Joel Tyler Wood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235791328 PECOS PAC ID: 3173854072 Enrollment ID: I20220711000970 |
| Provider Name | Kristin A Sharp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154881993 PECOS PAC ID: 3779817986 Enrollment ID: I20220801002197 |
| Provider Name | Robert J Austin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1083677439 PECOS PAC ID: 5991761488 Enrollment ID: I20220809004052 |
| Provider Name | Collese Nicole Mckee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730810078 PECOS PAC ID: 1759764483 Enrollment ID: I20220812002898 |
| Provider Name | Gina Elaina Verteramo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609502608 PECOS PAC ID: 4688057029 Enrollment ID: I20220817001299 |
| Provider Name | Shauntel Nichole Marcin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689305948 PECOS PAC ID: 1658754619 Enrollment ID: I20220824001210 |
| Provider Name | Tyler David Reamsnyder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316407794 PECOS PAC ID: 1850624230 Enrollment ID: I20220829001690 |
| Provider Name | Rebecca Anne Romine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861118069 PECOS PAC ID: 4880061357 Enrollment ID: I20221114001354 |
| Provider Name | Rudolph Altergott |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1417910803 PECOS PAC ID: 5991617276 Enrollment ID: I20221128000387 |
| Provider Name | Kelsey Anna Wagoner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144941758 PECOS PAC ID: 2769851872 Enrollment ID: I20221213000715 |
| Provider Name | Megan Nicole Brunner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477269603 PECOS PAC ID: 8628440856 Enrollment ID: I20230215002525 |
| Provider Name | Dimitrios Topalidis |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1578611182 PECOS PAC ID: 0941429732 Enrollment ID: I20230420001508 |
| Provider Name | Katherine Ann O'leary |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1538695606 PECOS PAC ID: 9436497245 Enrollment ID: I20230808000570 |
| Provider Name | Shea Lee Warner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063104370 PECOS PAC ID: 7618339664 Enrollment ID: I20230808003742 |
| Provider Name | Ashley B Walorski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457032518 PECOS PAC ID: 1052774247 Enrollment ID: I20230906001748 |
| Provider Name | Breanne Nichole Lawrence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609554997 PECOS PAC ID: 9638523970 Enrollment ID: I20230920003569 |
| Provider Name | Abigail C Abbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770262156 PECOS PAC ID: 7214381748 Enrollment ID: I20231002002262 |
| Provider Name | Daniel S Buzalski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699280602 PECOS PAC ID: 5799130787 Enrollment ID: I20231011001878 |
| Provider Name | Miloni Shroff |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1447488028 PECOS PAC ID: 5294956413 Enrollment ID: I20231016000699 |
| Provider Name | Ambreen Khalil |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1063564268 PECOS PAC ID: 2163618406 Enrollment ID: I20231025002782 |
| Provider Name | William Correll |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154371581 PECOS PAC ID: 5799750618 Enrollment ID: I20231115001998 |
| Provider Name | Ignacio Sarmina |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1861435554 PECOS PAC ID: 7618878224 Enrollment ID: I20231129003691 |
| Provider Name | John Patrick Dougherty |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1053722934 PECOS PAC ID: 8123325297 Enrollment ID: I20240109004280 |
| Provider Name | Ekaterina Sue Weaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861269110 PECOS PAC ID: 9436593530 Enrollment ID: I20240216001575 |
| Provider Name | Pedro Roca |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427059278 PECOS PAC ID: 9133122856 Enrollment ID: I20240314000197 |
| Provider Name | Robert R Isacksen |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1972546059 PECOS PAC ID: 7719899293 Enrollment ID: I20240319000462 |
| Provider Name | Sarah Shewayish |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1689936437 PECOS PAC ID: 8123340205 Enrollment ID: I20240419002384 |
| Provider Name | Frederico Guilherme Rocha |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417149022 PECOS PAC ID: 6709901622 Enrollment ID: I20240520001668 |
| Provider Name | Donald Garbett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285878728 PECOS PAC ID: 9537472360 Enrollment ID: I20240611001447 |
Byron M. Holm, Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2855 Miller Dr, Suite 117, Plymouth, IN 46563 Phone: 574-936-7777 Fax: 574-941-1072 | |
Proactive Md Plymouth Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 504 Colonial Ct, Plymouth, IN 46563 Phone: 812-645-1892 | |
Lifeplex Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2855 Miller Dr Ste 117, Plymouth, IN 46563 Phone: 574-936-7777 Fax: 574-941-1072 | |
Family Medicine Center Of Plymouth Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 105 Water St, Plymouth, IN 46563 Phone: 574-936-3178 Fax: 574-936-1084 | |
Holm Medical Clinic Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2855 Miller Dr Ste 205, Plymouth, IN 46563 Phone: 574-286-0200 | |
Saint Joseph Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1919 Lake Ave Ste 102b, Plymouth, IN 46563 Phone: 574-335-6800 Fax: 574-948-5480 |