| South Bend Clinic | |
|
211 N Eddy St South Bend IN 46617-2808 | |
| (574) 299-2450 | |
| (574) 299-2415 |
| Full Name | South Bend Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 211 N Eddy St, South Bend, Indiana |
| Authorized Official Name and Position | Paul J Meyer (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5742379201 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Bend Clinic 6301 University Commons Ste 230 South Bend IN 46635-1590 Ph: (574) 251-2115 | South Bend Clinic 211 N Eddy St South Bend IN 46617-2808 Ph: (574) 299-2450 |
| NPI Number | 1073680419 |
|---|---|
| Provider Enumeration Date | 11/29/2006 |
| Last Update Date | 07/10/2024 |
| Medicare PECOS PAC ID | 3779577937 |
|---|---|
| Medicare Enrollment ID | O20040412000439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073680419 | NPI | - | NPPES |
| 100442630 | Medicaid | IN |
| Provider Name | Wendell Garcia-ortiz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972593630 PECOS PAC ID: 4486556792 Enrollment ID: I20040126000468 |
| Provider Name | Miles B Andrew |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1689692188 PECOS PAC ID: 3173509106 Enrollment ID: I20040629000586 |
| Provider Name | Walter D Kolmodin |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1265427645 PECOS PAC ID: 4082680186 Enrollment ID: I20040909000810 |
| Provider Name | Ajazuddin Z Shaikh |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1225032626 PECOS PAC ID: 9234020801 Enrollment ID: I20041002000133 |
| Provider Name | Donald R Westerhausen |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1871598235 PECOS PAC ID: 9032000609 Enrollment ID: I20041002000142 |
| Provider Name | Rajendra V Shah |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1013961333 PECOS PAC ID: 4183684822 Enrollment ID: I20041015000932 |
| Provider Name | Ahmed A. Abdel Latief |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1093704801 PECOS PAC ID: 2365402054 Enrollment ID: I20041018000164 |
| Provider Name | Thomas G Akre |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1235132903 PECOS PAC ID: 4284694332 Enrollment ID: I20041026000443 |
| Provider Name | Sloan S Shah |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326093451 PECOS PAC ID: 0345202305 Enrollment ID: I20041102000064 |
| Provider Name | Uday Narahari |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134176332 PECOS PAC ID: 9638145105 Enrollment ID: I20041110000033 |
| Provider Name | Yakov G Belenky |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1760588149 PECOS PAC ID: 7012986987 Enrollment ID: I20041115001125 |
| Provider Name | Nicole Anest |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1255438644 PECOS PAC ID: 9638128481 Enrollment ID: I20050119000252 |
| Provider Name | Anthony C Cheng |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1548267875 PECOS PAC ID: 0244284487 Enrollment ID: I20050310000060 |
| Provider Name | Curtiss A. Wall |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1891789111 PECOS PAC ID: 7012957608 Enrollment ID: I20050503000946 |
| Provider Name | Andrey P Seluzhitskiy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568452902 PECOS PAC ID: 1658351788 Enrollment ID: I20050909000816 |
| Provider Name | Ebonee L Davis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295725646 PECOS PAC ID: 1759313786 Enrollment ID: I20050909000834 |
| Provider Name | Elizabeth A Weston Hammang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639169188 PECOS PAC ID: 2365475464 Enrollment ID: I20050917000440 |
| Provider Name | Cheryl Ann Sharp |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1821183674 PECOS PAC ID: 3173542610 Enrollment ID: I20051115000127 |
| Provider Name | Jeffery David Regal |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1235203878 PECOS PAC ID: 2961424734 Enrollment ID: I20051221000089 |
| Provider Name | Michael C Rotkis |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1134106297 PECOS PAC ID: 4183648975 Enrollment ID: I20060119000513 |
| Provider Name | Eugene Huang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164414173 PECOS PAC ID: 3173424363 Enrollment ID: I20060207000883 |
| Provider Name | Jon Blake Chadwell |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1255380903 PECOS PAC ID: 5395773303 Enrollment ID: I20060711000067 |
| Provider Name | Cameron Richard Gongwer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710904321 PECOS PAC ID: 4981601044 Enrollment ID: I20061102000212 |
| Provider Name | James A Mcpencow |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1710929500 PECOS PAC ID: 5193724060 Enrollment ID: I20061204000612 |
| Provider Name | David C Bertoncini |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336166941 PECOS PAC ID: 4880660406 Enrollment ID: I20061229000361 |
| Provider Name | Barbara Stitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790718476 PECOS PAC ID: 6709983729 Enrollment ID: I20070525000076 |
| Provider Name | Jennifer Snyder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770573040 PECOS PAC ID: 5799884110 Enrollment ID: I20070626000747 |
| Provider Name | Naseer H Nasser |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1063436582 PECOS PAC ID: 7315956562 Enrollment ID: I20070917000260 |
| Provider Name | Christina O Barnes |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1689790248 PECOS PAC ID: 6103912951 Enrollment ID: I20071010000193 |
| Provider Name | Asima Rashid |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245381029 PECOS PAC ID: 6305935370 Enrollment ID: I20071129000275 |
| Provider Name | Timothy J Durham |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1811987613 PECOS PAC ID: 6800983750 Enrollment ID: I20080129000292 |
| Provider Name | Jason J Spoljoric |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1821273905 PECOS PAC ID: 6305929829 Enrollment ID: I20080207000106 |
| Provider Name | Jeffrey L Niespodziany |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1548255292 PECOS PAC ID: 7113991001 Enrollment ID: I20080717000241 |
| Provider Name | Kent T Lancaster |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528093937 PECOS PAC ID: 2365411675 Enrollment ID: I20090220000105 |
| Provider Name | Ayis T Pyrros |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487824777 PECOS PAC ID: 2466502844 Enrollment ID: I20090605000009 |
| Provider Name | Rachelina P Kvietkus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376586420 PECOS PAC ID: 7315093192 Enrollment ID: I20090921000010 |
| Provider Name | Sara Ruth Hake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679806939 PECOS PAC ID: 5294872743 Enrollment ID: I20091102000427 |
| Provider Name | Steven P Crowell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003806829 PECOS PAC ID: 3173610029 Enrollment ID: I20091202000064 |
| Provider Name | Curtis L Gongwer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043200629 PECOS PAC ID: 0446347397 Enrollment ID: I20091202000082 |
| Provider Name | Thomas P Seasly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063402444 PECOS PAC ID: 5698862555 Enrollment ID: I20091202000099 |
| Provider Name | Alice S Lusk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487644845 PECOS PAC ID: 0345337291 Enrollment ID: I20091202000409 |
| Provider Name | Holly L Hake Harris |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1538159207 PECOS PAC ID: 1355438201 Enrollment ID: I20091203000603 |
| Provider Name | James B Harris |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1275523722 PECOS PAC ID: 3072600923 Enrollment ID: I20091204000228 |
| Provider Name | Bradley J Scott |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720078835 PECOS PAC ID: 3870680739 Enrollment ID: I20091210000377 |
| Provider Name | Christopher J Quinn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073503512 PECOS PAC ID: 6507953452 Enrollment ID: I20091211000362 |
| Provider Name | Robert S Oppman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720078256 PECOS PAC ID: 4789771635 Enrollment ID: I20091211000426 |
| Provider Name | Brian N Carter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366432429 PECOS PAC ID: 2466549316 Enrollment ID: I20091214000187 |
| Provider Name | Edward P Delle Donne |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1053398123 PECOS PAC ID: 5597761320 Enrollment ID: I20091217000583 |
| Provider Name | Scott A Blickensderfer |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1578568572 PECOS PAC ID: 9537209721 Enrollment ID: I20091219000021 |
| Provider Name | Kathleen M Delnay |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1811992803 PECOS PAC ID: 7517007701 Enrollment ID: I20091219000038 |
| Provider Name | Todd Rozycki |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1407846967 PECOS PAC ID: 9234226184 Enrollment ID: I20091221000176 |
| Provider Name | Cynthia E Mayfield |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1649260233 PECOS PAC ID: 7517054463 Enrollment ID: I20091221000227 |
| Provider Name | Timothy W Noveroske |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1285611442 PECOS PAC ID: 4789680513 Enrollment ID: I20091222000259 |
| Provider Name | John A Hudak |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1831194919 PECOS PAC ID: 2860598695 Enrollment ID: I20091223000272 |
| Provider Name | Ziya D Toper |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1245224526 PECOS PAC ID: 0840334462 Enrollment ID: I20100220000332 |
| Provider Name | Steven D Whaley |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1205971165 PECOS PAC ID: 2062542459 Enrollment ID: I20100610001092 |
| Provider Name | Alfredo V Casetti |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1679562383 PECOS PAC ID: 4183711039 Enrollment ID: I20100628000034 |
| Provider Name | Jeffrey A Steele |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1497912844 PECOS PAC ID: 2264563329 Enrollment ID: I20100706000666 |
| Provider Name | Jeffrey C Cooper |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1871562975 PECOS PAC ID: 6406833409 Enrollment ID: I20100714000783 |
| Provider Name | Randall I Kline |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1659366276 PECOS PAC ID: 4082674031 Enrollment ID: I20100806000719 |
| Provider Name | Sonia Del Real |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1689986549 PECOS PAC ID: 5294869194 Enrollment ID: I20100813000733 |
| Provider Name | Sylvan E Clarke |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1730396441 PECOS PAC ID: 4587798038 Enrollment ID: I20100819000117 |
| Provider Name | Robert Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225031925 PECOS PAC ID: 9436151701 Enrollment ID: I20100824001058 |
| Provider Name | William J Granger |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1619960671 PECOS PAC ID: 6305961376 Enrollment ID: I20100914000834 |
| Provider Name | Nancy C Keller Madden |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1457341141 PECOS PAC ID: 3971690827 Enrollment ID: I20101029000086 |
| Provider Name | Ersalan Rahman |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1033163894 PECOS PAC ID: 3678518156 Enrollment ID: I20101227000066 |
| Provider Name | Matthew A Jachim |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1427095637 PECOS PAC ID: 4284778010 Enrollment ID: I20110411000397 |
| Provider Name | Mark E Nielson |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1942407838 PECOS PAC ID: 2668658808 Enrollment ID: I20110524000071 |
| Provider Name | Crystal S Beneker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457658130 PECOS PAC ID: 9739367780 Enrollment ID: I20110622000691 |
| Provider Name | Daniel F Czarnecki |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124224373 PECOS PAC ID: 7911176128 Enrollment ID: I20110804000236 |
| Provider Name | Almira Hadzimesic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093003956 PECOS PAC ID: 7214106293 Enrollment ID: I20110809000007 |
| Provider Name | Rita A Schmid |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306057724 PECOS PAC ID: 7012061948 Enrollment ID: I20110824000775 |
| Provider Name | Luis Alfonso Benavente Chenhalls |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164445433 PECOS PAC ID: 1557364080 Enrollment ID: I20111006000573 |
| Provider Name | Melissa Gutierrez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1366723769 PECOS PAC ID: 7911179973 Enrollment ID: I20111017000574 |
| Provider Name | Brent Mohr |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1710977319 PECOS PAC ID: 1153418009 Enrollment ID: I20111104000056 |
| Provider Name | Maria Evangelista |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871583674 PECOS PAC ID: 8628165578 Enrollment ID: I20111104000417 |
| Provider Name | Paul H Desmarais |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1376642249 PECOS PAC ID: 6608040043 Enrollment ID: I20111121000173 |
| Provider Name | Raymond Canda |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1487931184 PECOS PAC ID: 5698949600 Enrollment ID: I20111130000647 |
| Provider Name | David M Sabato |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1992795447 PECOS PAC ID: 1052408903 Enrollment ID: I20111227000505 |
| Provider Name | Saira Rahman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1497902571 PECOS PAC ID: 2062580574 Enrollment ID: I20111230000278 |
| Provider Name | John L Rice |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1669462131 PECOS PAC ID: 7416044367 Enrollment ID: I20120131000654 |
| Provider Name | Kelly M Losiniecki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013288448 PECOS PAC ID: 3476714759 Enrollment ID: I20120412000637 |
| Provider Name | Roni Aizigov |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1174876577 PECOS PAC ID: 1658517834 Enrollment ID: I20130412000298 |
| Provider Name | Dayna M Cox |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1144489790 PECOS PAC ID: 4183875073 Enrollment ID: I20130419000167 |
| Provider Name | Maher D Abu-hamdan |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1144431503 PECOS PAC ID: 6901938166 Enrollment ID: I20130821000663 |
| Provider Name | Cynthia M Seigel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740467539 PECOS PAC ID: 4981847589 Enrollment ID: I20130829000749 |
| Provider Name | Marcia J Kostka-suvelza |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1811972680 PECOS PAC ID: 1759518749 Enrollment ID: I20131219000602 |
| Provider Name | Mark J Knott |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1164718789 PECOS PAC ID: 2365689056 Enrollment ID: I20140213001041 |
| Provider Name | Thalia R Pachiyannakis |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1275860314 PECOS PAC ID: 0345473732 Enrollment ID: I20140509001742 |
| Provider Name | Jessica A Blomeke |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1932419371 PECOS PAC ID: 4082896154 Enrollment ID: I20140513001866 |
| Provider Name | Bradley Yensho |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1821415993 PECOS PAC ID: 0941424923 Enrollment ID: I20140612002275 |
| Provider Name | Melissa Hickey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1902004872 PECOS PAC ID: 3678713559 Enrollment ID: I20140613001956 |
| Provider Name | Daniel E Brier |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1538159009 PECOS PAC ID: 1557458403 Enrollment ID: I20140616000054 |
| Provider Name | Muhammad Saafir |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932435229 PECOS PAC ID: 9830337088 Enrollment ID: I20140702000150 |
| Provider Name | Allen R Clark |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1891013967 PECOS PAC ID: 0941425680 Enrollment ID: I20140714000373 |
| Provider Name | April J Rasnic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699009902 PECOS PAC ID: 5496971509 Enrollment ID: I20140725001977 |
| Provider Name | Mikael D Howard |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1114243573 PECOS PAC ID: 1557580602 Enrollment ID: I20140922002682 |
| Provider Name | Natalie A Emmert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285058081 PECOS PAC ID: 5991925992 Enrollment ID: I20140925000132 |
| Provider Name | Hilary C Slemp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134532815 PECOS PAC ID: 1456576933 Enrollment ID: I20141106002282 |
| Provider Name | Melissa M Bartoszewicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699183822 PECOS PAC ID: 6800018144 Enrollment ID: I20141120002288 |
| Provider Name | Brandon W Alt |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1912306853 PECOS PAC ID: 5698097723 Enrollment ID: I20141201001069 |
| Provider Name | Matthew Franz |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1295029965 PECOS PAC ID: 9830335769 Enrollment ID: I20150227000752 |
| Provider Name | Zhiquan Zhao |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1073714549 PECOS PAC ID: 3678649597 Enrollment ID: I20150326000811 |
| Provider Name | Matthew Norton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205064870 PECOS PAC ID: 9335387497 Enrollment ID: I20150407000546 |
| Provider Name | Jennifer P Heaney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164814760 PECOS PAC ID: 9931428885 Enrollment ID: I20150428000664 |
| Provider Name | Susan A Snider |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548652886 PECOS PAC ID: 5799005690 Enrollment ID: I20150515001891 |
| Provider Name | Jean M Bahu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669869954 PECOS PAC ID: 2264752799 Enrollment ID: I20150522000838 |
| Provider Name | Brian S Schmutzler |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1063711745 PECOS PAC ID: 3274770078 Enrollment ID: I20150603002362 |
| Provider Name | Thomas Larsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285998146 PECOS PAC ID: 1355589284 Enrollment ID: I20150611000123 |
| Provider Name | Kathryn Latimer Werda |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063502847 PECOS PAC ID: 5890704399 Enrollment ID: I20150701001972 |
| Provider Name | Bryan Stowell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720460314 PECOS PAC ID: 6204144876 Enrollment ID: I20150930002958 |
| Provider Name | Patrick J Brand |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1033373295 PECOS PAC ID: 7012083603 Enrollment ID: I20160113002515 |
| Provider Name | Michael R Mcbride |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578858676 PECOS PAC ID: 5395977557 Enrollment ID: I20160511000463 |
| Provider Name | Sohaib Aleem |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1588894026 PECOS PAC ID: 7012188543 Enrollment ID: I20160617000277 |
| Provider Name | Marc Oudghiri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952764409 PECOS PAC ID: 5193016798 Enrollment ID: I20160628002327 |
| Provider Name | Alicia M Wilson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285070284 PECOS PAC ID: 8325330780 Enrollment ID: I20160706001242 |
| Provider Name | Rickyn Patel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1972821825 PECOS PAC ID: 9032402623 Enrollment ID: I20160719002405 |
| Provider Name | Lindsay K Vasil |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1093169096 PECOS PAC ID: 1658664834 Enrollment ID: I20160726001056 |
| Provider Name | Alexa R Morningstar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356790034 PECOS PAC ID: 8729373550 Enrollment ID: I20160818000962 |
| Provider Name | Jay W Biesenthal |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1669471827 PECOS PAC ID: 7113989823 Enrollment ID: I20160826000227 |
| Provider Name | Louis C Cavadini |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023422128 PECOS PAC ID: 1153546486 Enrollment ID: I20161014000509 |
| Provider Name | Melinda C Nwanganga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386192870 PECOS PAC ID: 8426339037 Enrollment ID: I20161219002148 |
| Provider Name | Michael N Scheretie |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1740728948 PECOS PAC ID: 6204111883 Enrollment ID: I20170322000921 |
| Provider Name | Lyndsay Gable |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518408137 PECOS PAC ID: 1850677113 Enrollment ID: I20170421000206 |
| Provider Name | Jessica Marie Basham |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1164764890 PECOS PAC ID: 6608170717 Enrollment ID: I20170519000667 |
| Provider Name | Emily J Heasley |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1295174530 PECOS PAC ID: 4688806276 Enrollment ID: I20170614000266 |
| Provider Name | Sara Baumgartner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043654361 PECOS PAC ID: 3375859853 Enrollment ID: I20170712002188 |
| Provider Name | Elizabeth A Slavinskas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548623283 PECOS PAC ID: 4183995517 Enrollment ID: I20170803002255 |
| Provider Name | Sidrah Zaidi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023417425 PECOS PAC ID: 0840509907 Enrollment ID: I20170817002786 |
| Provider Name | John Felker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1679514996 PECOS PAC ID: 9931163052 Enrollment ID: I20170824002757 |
| Provider Name | Paige E Cisna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578090650 PECOS PAC ID: 1557633500 Enrollment ID: I20170825000661 |
| Provider Name | Aaron C Woodward |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1457871030 PECOS PAC ID: 9537434436 Enrollment ID: I20171003005213 |
| Provider Name | Rachael A Harris Sprunger |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1457611865 PECOS PAC ID: 4688816077 Enrollment ID: I20171003006599 |
| Provider Name | Malee Blue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730626979 PECOS PAC ID: 2961769609 Enrollment ID: I20171205001040 |
| Provider Name | Miriam Kirori |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1568967461 PECOS PAC ID: 1557624541 Enrollment ID: I20180404000210 |
| Provider Name | Ricki A Loenser |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1649635426 PECOS PAC ID: 3678878337 Enrollment ID: I20180410002862 |
| Provider Name | Michael Pfeiffer |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1295078228 PECOS PAC ID: 6507121449 Enrollment ID: I20180524002341 |
| Provider Name | Laura E Albright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912388018 PECOS PAC ID: 2961714670 Enrollment ID: I20180706000876 |
| Provider Name | Robert A Cassady |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407206824 PECOS PAC ID: 2860775848 Enrollment ID: I20180831000722 |
| Provider Name | Caroline L Mcdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922342500 PECOS PAC ID: 9032469010 Enrollment ID: I20180912003170 |
| Provider Name | Matthew Robert Misner |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1366637555 PECOS PAC ID: 8224206149 Enrollment ID: I20181011002295 |
| Provider Name | Christine M Healy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427539758 PECOS PAC ID: 8123371739 Enrollment ID: I20181029003135 |
| Provider Name | Kristin Marie Wymer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679058762 PECOS PAC ID: 9830442029 Enrollment ID: I20181106001232 |
| Provider Name | Sabrina J Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467929570 PECOS PAC ID: 4880930296 Enrollment ID: I20190107000526 |
| Provider Name | Jonathan E Ditty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518316140 PECOS PAC ID: 0345532214 Enrollment ID: I20190618001094 |
| Provider Name | Briana R Weidler-edholm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144882069 PECOS PAC ID: 9032448808 Enrollment ID: I20190904003243 |
| Provider Name | Ryan T Hagley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1154830396 PECOS PAC ID: 4486929346 Enrollment ID: I20190905000749 |
| Provider Name | Megan Hagley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1518381094 PECOS PAC ID: 9436380912 Enrollment ID: I20190905001581 |
| Provider Name | Bronson Taylor |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1508423039 PECOS PAC ID: 9537499538 Enrollment ID: I20190917003668 |
| Provider Name | Michael Redd |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1033454889 PECOS PAC ID: 8325283294 Enrollment ID: I20191118000489 |
| Provider Name | Steven D Schmeling |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1801156435 PECOS PAC ID: 7214186212 Enrollment ID: I20191120001271 |
| Provider Name | Anatoliy Rudin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1326300260 PECOS PAC ID: 1759527369 Enrollment ID: I20191123000211 |
| Provider Name | Jillian Anne Westerhausen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255795001 PECOS PAC ID: 1951692136 Enrollment ID: I20200103002092 |
| Provider Name | Joshua C Stewart |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1083258099 PECOS PAC ID: 6608201694 Enrollment ID: I20200122000772 |
| Provider Name | Mary A Behrens |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1528433463 PECOS PAC ID: 6800222746 Enrollment ID: I20200212001553 |
| Provider Name | Theodore T Korty |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1134580863 PECOS PAC ID: 6103124417 Enrollment ID: I20200603003177 |
| Provider Name | Tess L Curnyn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891222808 PECOS PAC ID: 8123397015 Enrollment ID: I20200721002906 |
| Provider Name | Javier Galan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760923023 PECOS PAC ID: 3072937275 Enrollment ID: I20200721002970 |
| Provider Name | Mackenzie Austgen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1477903391 PECOS PAC ID: 4082038781 Enrollment ID: I20200727003169 |
| Provider Name | Meng M Yu |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1861882763 PECOS PAC ID: 9133449556 Enrollment ID: I20200914000454 |
| Provider Name | Joseph Statz |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1225444045 PECOS PAC ID: 2769608199 Enrollment ID: I20201008001568 |
| Provider Name | Jamie A Garvey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1265995500 PECOS PAC ID: 6800216052 Enrollment ID: I20201009000587 |
| Provider Name | Hassan Sawaf |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588295448 PECOS PAC ID: 2769892496 Enrollment ID: I20201106002253 |
| Provider Name | Lenser A Ochieng |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1285015560 PECOS PAC ID: 4789997503 Enrollment ID: I20201215000072 |
| Provider Name | Stephanie L Unger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255927828 PECOS PAC ID: 6901210103 Enrollment ID: I20210129001437 |
| Provider Name | Joshua Bowling |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1750744223 PECOS PAC ID: 5991098147 Enrollment ID: I20210422000866 |
| Provider Name | Stephanie L Cross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932791928 PECOS PAC ID: 6204245186 Enrollment ID: I20210505001189 |
| Provider Name | Rebecca J Mahlie |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1932783958 PECOS PAC ID: 8820499924 Enrollment ID: I20210628000635 |
| Provider Name | Micah Yarrow Spencer |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1558850164 PECOS PAC ID: 8224383716 Enrollment ID: I20210723002056 |
| Provider Name | Stephen D Matteson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740895887 PECOS PAC ID: 6608279856 Enrollment ID: I20210726001173 |
| Provider Name | Paul Brian Sexton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265914428 PECOS PAC ID: 9638573082 Enrollment ID: I20210806000392 |
| Provider Name | Erwin Thimm |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609857242 PECOS PAC ID: 7618937624 Enrollment ID: I20210806001424 |
| Provider Name | Robert Alan Fiedler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962074583 PECOS PAC ID: 4385048560 Enrollment ID: I20210810002850 |
| Provider Name | Gerald H Espiritu |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1316092273 PECOS PAC ID: 9537295720 Enrollment ID: I20210819002030 |
| Provider Name | Sarah A Von Der Mehden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902209984 PECOS PAC ID: 3577968122 Enrollment ID: I20210820000864 |
| Provider Name | Darah J Regal |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1093480618 PECOS PAC ID: 7719383751 Enrollment ID: I20210831001277 |
| Provider Name | Liwei L Hua |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497885131 PECOS PAC ID: 9335225507 Enrollment ID: I20210831001348 |
| Provider Name | Mohamad F Bazerbashi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518223841 PECOS PAC ID: 8527210095 Enrollment ID: I20211006000342 |
| Provider Name | Muhammad Hammadah |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1427314459 PECOS PAC ID: 3173953296 Enrollment ID: I20211007000148 |
| Provider Name | William Whitacre |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1588635635 PECOS PAC ID: 0143312512 Enrollment ID: I20211007001222 |
| Provider Name | Andrew Gerughty |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1881042406 PECOS PAC ID: 2668752031 Enrollment ID: I20211130000839 |
| Provider Name | Alexandra R Liberi |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1730846825 PECOS PAC ID: 4587054127 Enrollment ID: I20211214001256 |
| Provider Name | David C Choe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477555027 PECOS PAC ID: 8123926953 Enrollment ID: I20211220001007 |
| Provider Name | Christina Reddy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376919605 PECOS PAC ID: 5193023562 Enrollment ID: I20211222000469 |
| Provider Name | Lisansha S Zahirsha |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154749901 PECOS PAC ID: 0446555882 Enrollment ID: I20220112000646 |
| Provider Name | Daniel S Son |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114331451 PECOS PAC ID: 1052670890 Enrollment ID: I20220112001016 |
| Provider Name | Kelly E Crowley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730836982 PECOS PAC ID: 4880089259 Enrollment ID: I20220322000720 |
| Provider Name | Lisa Lobel |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1245494699 PECOS PAC ID: 9335472620 Enrollment ID: I20220630002514 |
| Provider Name | Kristin A Sharp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154881993 PECOS PAC ID: 3779817986 Enrollment ID: I20220801002197 |
| Provider Name | Alice C Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063020279 PECOS PAC ID: 3274916994 Enrollment ID: I20220812002504 |
| Provider Name | Natalie Fay Burkhart |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073177788 PECOS PAC ID: 9830432285 Enrollment ID: I20220817000398 |
| Provider Name | Michelle I Scott |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1811492655 PECOS PAC ID: 5597148973 Enrollment ID: I20220817003123 |
| Provider Name | Justin C Reed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174083422 PECOS PAC ID: 0648503029 Enrollment ID: I20220822002003 |
| Provider Name | Lekshmi Nair |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033317383 PECOS PAC ID: 8628120029 Enrollment ID: I20220825003055 |
| Provider Name | Momin Muzaffar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588690812 PECOS PAC ID: 3173559655 Enrollment ID: I20220907002190 |
| Provider Name | Nafisa B Ibrahim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053532002 PECOS PAC ID: 6800110099 Enrollment ID: I20220908000318 |
| Provider Name | Amar S Mehta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477828523 PECOS PAC ID: 1153623749 Enrollment ID: I20220908000427 |
| Provider Name | Rajit S Shetty |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881662245 PECOS PAC ID: 2567404221 Enrollment ID: I20220908000429 |
| Provider Name | Rachelle C Centeno |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780827337 PECOS PAC ID: 6406074228 Enrollment ID: I20220919000637 |
| Provider Name | Nasir A Siddiqui |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285925248 PECOS PAC ID: 8325202070 Enrollment ID: I20220919002398 |
| Provider Name | Mairaj M Uddin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689037855 PECOS PAC ID: 8426453556 Enrollment ID: I20220922001691 |
| Provider Name | Katherine T Tian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144888017 PECOS PAC ID: 1557696200 Enrollment ID: I20220922001696 |
| Provider Name | Kyle C Kallenbach |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477529626 PECOS PAC ID: 5991690844 Enrollment ID: I20220922001798 |
| Provider Name | Tammam Nehme |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689652190 PECOS PAC ID: 1850381799 Enrollment ID: I20220922002367 |
| Provider Name | Diane L Scott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528323938 PECOS PAC ID: 3072849660 Enrollment ID: I20220927003584 |
| Provider Name | Juliet H Fallah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841275815 PECOS PAC ID: 3274503289 Enrollment ID: I20220929000789 |
| Provider Name | Andrew Weatherington |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1346978319 PECOS PAC ID: 3779969639 Enrollment ID: I20220929001173 |
| Provider Name | Amy Karanja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063162881 PECOS PAC ID: 6608252408 Enrollment ID: I20221003000322 |
| Provider Name | Shannon L Roach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962125336 PECOS PAC ID: 7911383609 Enrollment ID: I20221004001111 |
| Provider Name | James T Oakey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902873375 PECOS PAC ID: 2860481074 Enrollment ID: I20221019002589 |
| Provider Name | Bisher Tarabishy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1760682249 PECOS PAC ID: 7214184225 Enrollment ID: I20230103002239 |
| Provider Name | Ellen E Cunningham |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1205902186 PECOS PAC ID: 3678627346 Enrollment ID: I20230227002119 |
| Provider Name | Emily Anne Peak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154037398 PECOS PAC ID: 8022482298 Enrollment ID: I20230330000817 |
| Provider Name | Philip Persino |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1891291563 PECOS PAC ID: 8022357540 Enrollment ID: I20230405002286 |
| Provider Name | Lacy Lee Katowich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902421076 PECOS PAC ID: 5698130904 Enrollment ID: I20230420000411 |
| Provider Name | Christopher John Eberle |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1689200552 PECOS PAC ID: 4082036132 Enrollment ID: I20230518001856 |
| Provider Name | Emma K Dunfee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013477355 PECOS PAC ID: 7012240401 Enrollment ID: I20230613003371 |
| Provider Name | Mei Wang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538843370 PECOS PAC ID: 4981062122 Enrollment ID: I20230621001543 |
| Provider Name | Kelsey L Jurgonski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508550054 PECOS PAC ID: 4486012143 Enrollment ID: I20230628001065 |
| Provider Name | Rachael L Ferrero |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1881386019 PECOS PAC ID: 4981067709 Enrollment ID: I20230828001235 |
| Provider Name | Denise D Imperial |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1417630179 PECOS PAC ID: 8022463637 Enrollment ID: I20231017000227 |
| Provider Name | Katherine J Alizo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073108601 PECOS PAC ID: 7012309339 Enrollment ID: I20231030000790 |
| Provider Name | Victoria R Eichorn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851173181 PECOS PAC ID: 7810343415 Enrollment ID: I20231101003198 |
| Provider Name | Heather S Gengnagel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467222331 PECOS PAC ID: 2163865577 Enrollment ID: I20240213000385 |
| Provider Name | Ajeet Singh Mehta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811254592 PECOS PAC ID: 1052614211 Enrollment ID: I20240311000598 |
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Mcdonald Physical Therapy Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1005 N Hickory Rd, South Bend, IN 46615 Phone: 574-233-5754 Fax: 574-233-7406 | |
Uthman Cavallo, Md, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 53800 Generations Dr, South Bend, IN 46635 Phone: 574-273-3880 Fax: 574-271-0918 | |
Bendix Family Physicians Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1010 N Bendix Dr, South Bend, IN 46628 Phone: 574-245-4980 Fax: 574-245-4981 | |
Beacon Medical Group Ireland Road Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1815 E Ireland Rd, South Bend, IN 46614 Phone: 574-647-1700 Fax: 574-291-3351 |