| Ssm Health Medical Group | |
|
4218 Lincolnshire Dr Mount Vernon IL 62864-2156 | |
| (618) 899-3600 | |
| Not Available |
| Full Name | Ssm Health Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 4218 Lincolnshire Dr, Mount Vernon, Illinois |
| Authorized Official Name and Position | Deland Evischi (VP FINANCE SMGSMG) |
| Authorized Official Contact | 6188991040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssm Health Medical Group 4218 Lincolnshire Dr Mount Vernon IL 62864-2156 Ph: (618) 899-3600 | Ssm Health Medical Group 4218 Lincolnshire Dr Mount Vernon IL 62864-2156 Ph: (618) 899-3600 |
| NPI Number | 1831101807 |
|---|---|
| Provider Enumeration Date | 08/11/2006 |
| Last Update Date | 08/25/2015 |
| Medicare PECOS PAC ID | 9234022567 |
|---|---|
| Medicare Enrollment ID | O20040304000583 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831101807 | NPI | - | NPPES |
| Provider Name | Mary K Piper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881648194 PECOS PAC ID: 6608774260 Enrollment ID: I20031222000206 |
| Provider Name | Lynn S Cook |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1508891219 PECOS PAC ID: 3971405804 Enrollment ID: I20040122000334 |
| Provider Name | Michael J Schifano |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1679507818 PECOS PAC ID: 8820987738 Enrollment ID: I20040310001415 |
| Provider Name | Hong Chen |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1023087152 PECOS PAC ID: 9931099652 Enrollment ID: I20040317000611 |
| Provider Name | Scott A Joyner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720018617 PECOS PAC ID: 8022909050 Enrollment ID: I20040322000211 |
| Provider Name | Emmanuel Loutrianakis |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1013974187 PECOS PAC ID: 6709867773 Enrollment ID: I20040526000358 |
| Provider Name | Cyrus D Solhkhah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174710347 PECOS PAC ID: 0547249088 Enrollment ID: I20040717000052 |
| Provider Name | Eric B Staros |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1750412359 PECOS PAC ID: 5193704419 Enrollment ID: I20040719001148 |
| Provider Name | Ronald Weiss |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1871548990 PECOS PAC ID: 9830176007 Enrollment ID: I20040809000089 |
| Provider Name | Peter Y Wong |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1952344509 PECOS PAC ID: 5597733261 Enrollment ID: I20040921000173 |
| Provider Name | Ajay Labroo |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1831199371 PECOS PAC ID: 7416924279 Enrollment ID: I20041018000030 |
| Provider Name | Jeffrey G Shanes |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1740236835 PECOS PAC ID: 1557338480 Enrollment ID: I20041105000968 |
| Provider Name | Lyle D Pahnke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770538225 PECOS PAC ID: 9931162302 Enrollment ID: I20041105001094 |
| Provider Name | Craig A Beyer |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1437134731 PECOS PAC ID: 3678540796 Enrollment ID: I20041108000512 |
| Provider Name | Douglas Combs |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1447218268 PECOS PAC ID: 7012977960 Enrollment ID: I20041130000499 |
| Provider Name | Tamara D Foltz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255394797 PECOS PAC ID: 9830137066 Enrollment ID: I20050419000984 |
| Provider Name | Kevin B Claffey |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1144226085 PECOS PAC ID: 0446203681 Enrollment ID: I20050421000578 |
| Provider Name | Rajendra R Shroff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245259274 PECOS PAC ID: 6103865381 Enrollment ID: I20050427000691 |
| Provider Name | Maamoun A Junidi |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1366488660 PECOS PAC ID: 9133021355 Enrollment ID: I20050427000733 |
| Provider Name | Roger C Joy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922183128 PECOS PAC ID: 4880633940 Enrollment ID: I20050427001359 |
| Provider Name | Christopher Leonard Vulin |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1801870126 PECOS PAC ID: 2668411356 Enrollment ID: I20050502001229 |
| Provider Name | Arnold M Herskovic |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1538185095 PECOS PAC ID: 5496734691 Enrollment ID: I20050624000279 |
| Provider Name | Raza S Hamdani |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1144207218 PECOS PAC ID: 7416920731 Enrollment ID: I20050818000499 |
| Provider Name | Michael A Covlin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1780641852 PECOS PAC ID: 1557327095 Enrollment ID: I20051222000475 |
| Provider Name | Janet R Merrell |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1447222419 PECOS PAC ID: 9537181938 Enrollment ID: I20051229000224 |
| Provider Name | Mahvish Zahoor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316909021 PECOS PAC ID: 1355238338 Enrollment ID: I20060123000888 |
| Provider Name | Rupal R Parmar |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1003846247 PECOS PAC ID: 6608881586 Enrollment ID: I20060214000370 |
| Provider Name | Jeffrey S Chalfant |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811935166 PECOS PAC ID: 9133136641 Enrollment ID: I20060308000449 |
| Provider Name | Christopher J Ostromecki |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1497746390 PECOS PAC ID: 9537159579 Enrollment ID: I20060322000607 |
| Provider Name | Jill Cacciabando |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356378467 PECOS PAC ID: 7012926678 Enrollment ID: I20060411000271 |
| Provider Name | Ralph I Latta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215956602 PECOS PAC ID: 4789694290 Enrollment ID: I20060428000045 |
| Provider Name | Jaidev Chand Soni |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1811978752 PECOS PAC ID: 9032120324 Enrollment ID: I20060530000132 |
| Provider Name | Bassam Al Joundi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1144277534 PECOS PAC ID: 0648264606 Enrollment ID: I20060608000047 |
| Provider Name | Graeme D Fisher |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1659362929 PECOS PAC ID: 9234141987 Enrollment ID: I20060620000063 |
| Provider Name | Ruth Lyons Rakey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669425526 PECOS PAC ID: 0941203046 Enrollment ID: I20060810000144 |
| Provider Name | Sudeep A Nair |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376582999 PECOS PAC ID: 8325041775 Enrollment ID: I20060824000472 |
| Provider Name | Alan S Harad |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1679579510 PECOS PAC ID: 7416951074 Enrollment ID: I20060913000230 |
| Provider Name | Elisabeth G Beyer Nolen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1306853684 PECOS PAC ID: 7618971284 Enrollment ID: I20060913000293 |
| Provider Name | Rajeev Varma |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1073525770 PECOS PAC ID: 9830194760 Enrollment ID: I20060927000072 |
| Provider Name | Andrew P Hoffman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1104934389 PECOS PAC ID: 1456246222 Enrollment ID: I20070330000525 |
| Provider Name | Eduardo Smith Singares |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1477554756 PECOS PAC ID: 6507898368 Enrollment ID: I20070621000193 |
| Provider Name | John E Dybis |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1639299977 PECOS PAC ID: 6507958352 Enrollment ID: I20070823000939 |
| Provider Name | Daniel Hoffman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134147432 PECOS PAC ID: 8628164795 Enrollment ID: I20071020000022 |
| Provider Name | Veena K Gupta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790713899 PECOS PAC ID: 3678532843 Enrollment ID: I20080226000790 |
| Provider Name | Walter A Parham |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1487646972 PECOS PAC ID: 7012984859 Enrollment ID: I20080506000499 |
| Provider Name | Brent W Schwarm |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932104296 PECOS PAC ID: 4789595299 Enrollment ID: I20080602000502 |
| Provider Name | Stacy D Menees |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386815959 PECOS PAC ID: 6103990841 Enrollment ID: I20080730000075 |
| Provider Name | Stefano Schena |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1447465356 PECOS PAC ID: 7416021498 Enrollment ID: I20080808000646 |
| Provider Name | Michele K Hartke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609031772 PECOS PAC ID: 0547337263 Enrollment ID: I20080923000227 |
| Provider Name | Emily B Boyd |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1730257924 PECOS PAC ID: 3375611957 Enrollment ID: I20081009000235 |
| Provider Name | Shalisa Anne Henson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598914905 PECOS PAC ID: 2365500725 Enrollment ID: I20081029000395 |
| Provider Name | Veena Kunigal |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1669443248 PECOS PAC ID: 5698796399 Enrollment ID: I20090515000430 |
| Provider Name | Jon William Taveau |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1083897086 PECOS PAC ID: 3072535772 Enrollment ID: I20090707000191 |
| Provider Name | Yousef N Abdulnabi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1811958689 PECOS PAC ID: 5991857393 Enrollment ID: I20090721000396 |
| Provider Name | Nazimuddin T Mohammed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316974249 PECOS PAC ID: 4284684663 Enrollment ID: I20090818000510 |
| Provider Name | Kathleen M Naegele |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1407004773 PECOS PAC ID: 0446304810 Enrollment ID: I20090819000585 |
| Provider Name | Faisal Rashid |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1851354690 PECOS PAC ID: 9133136450 Enrollment ID: I20090911000021 |
| Provider Name | Leslie A Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962647149 PECOS PAC ID: 0143368498 Enrollment ID: I20091106000510 |
| Provider Name | Naresh K Ahuja |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1013174598 PECOS PAC ID: 9830263870 Enrollment ID: I20100720000005 |
| Provider Name | Nelson K Wong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578563854 PECOS PAC ID: 6507998705 Enrollment ID: I20100723000675 |
| Provider Name | David J Huddleston |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1033170998 PECOS PAC ID: 0941495766 Enrollment ID: I20101105001139 |
| Provider Name | John A Flick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770782351 PECOS PAC ID: 9133314719 Enrollment ID: I20101109000442 |
| Provider Name | Nida Subhani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770747784 PECOS PAC ID: 3375738883 Enrollment ID: I20101110000543 |
| Provider Name | Luis Soruco |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1013065556 PECOS PAC ID: 7719875533 Enrollment ID: I20101111000576 |
| Provider Name | Esther L Schulz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093759730 PECOS PAC ID: 8628073871 Enrollment ID: I20101115000172 |
| Provider Name | Raymund O Pineda |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1841262789 PECOS PAC ID: 5698867034 Enrollment ID: I20101213000711 |
| Provider Name | Kristian Novakovic |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1518180272 PECOS PAC ID: 7214025378 Enrollment ID: I20101228000179 |
| Provider Name | Donald P Prentiss |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1275617839 PECOS PAC ID: 9436130507 Enrollment ID: I20110104001195 |
| Provider Name | R Deva Nathan |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1700987708 PECOS PAC ID: 0648227348 Enrollment ID: I20110119001262 |
| Provider Name | Susan G Marantz |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1881755684 PECOS PAC ID: 4981885761 Enrollment ID: I20110228000289 |
| Provider Name | Debra Ann Carson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043410392 PECOS PAC ID: 5799967410 Enrollment ID: I20110316000579 |
| Provider Name | Joanna E Janas-kaminsky |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194811430 PECOS PAC ID: 4486839446 Enrollment ID: I20110506000422 |
| Provider Name | Dawn Drewes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700177763 PECOS PAC ID: 4789862236 Enrollment ID: I20110701000375 |
| Provider Name | Sharron Gingrich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205821923 PECOS PAC ID: 6800824509 Enrollment ID: I20110705000194 |
| Provider Name | Deepu Sudhakaran |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1528269214 PECOS PAC ID: 9133397086 Enrollment ID: I20110719000719 |
| Provider Name | Jamie L Plett |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1033412531 PECOS PAC ID: 0840460655 Enrollment ID: I20110906000513 |
| Provider Name | Melissa Karaffa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356629612 PECOS PAC ID: 7810169216 Enrollment ID: I20111006000738 |
| Provider Name | Susan Buratto |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174788095 PECOS PAC ID: 5799958864 Enrollment ID: I20111105000105 |
| Provider Name | Sherry L Lynch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457599847 PECOS PAC ID: 3971778663 Enrollment ID: I20111207000815 |
| Provider Name | Merrilee Brandt |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1942243811 PECOS PAC ID: 6709831050 Enrollment ID: I20111227000146 |
| Provider Name | Kimberly Belangee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649401464 PECOS PAC ID: 3375710296 Enrollment ID: I20120118000192 |
| Provider Name | Laci C Jankowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689945339 PECOS PAC ID: 7214196336 Enrollment ID: I20120309000145 |
| Provider Name | Jose A Albisu |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1336272913 PECOS PAC ID: 5294995536 Enrollment ID: I20120324000094 |
| Provider Name | Aziz U Rahman |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1275540015 PECOS PAC ID: 2365602190 Enrollment ID: I20120402000042 |
| Provider Name | Jason Andrew Davison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871867465 PECOS PAC ID: 8325208093 Enrollment ID: I20120404000743 |
| Provider Name | Nadiene Ann Stock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083984306 PECOS PAC ID: 6608039482 Enrollment ID: I20120514000576 |
| Provider Name | Natalie Grace Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952688640 PECOS PAC ID: 1850550831 Enrollment ID: I20120817000251 |
| Provider Name | Hoang Chau Thi Nguyen |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1295742005 PECOS PAC ID: 4385652700 Enrollment ID: I20120820000828 |
| Provider Name | Imran N Ahmad |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1871760934 PECOS PAC ID: 5294880209 Enrollment ID: I20120828000901 |
| Provider Name | Tareq Zaza |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1447287412 PECOS PAC ID: 9638320443 Enrollment ID: I20121102000408 |
| Provider Name | Mohammed Asghar Hussain |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1225126535 PECOS PAC ID: 8022088145 Enrollment ID: I20130118000297 |
| Provider Name | Mohammed Siddiqui |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639456122 PECOS PAC ID: 8729224720 Enrollment ID: I20130417000630 |
| Provider Name | Kimberly Dawn Carter |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1891916847 PECOS PAC ID: 3375780828 Enrollment ID: I20130501000139 |
| Provider Name | Trina M Yenne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972847309 PECOS PAC ID: 3375780687 Enrollment ID: I20130506000031 |
| Provider Name | Tracy D Arnold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952660300 PECOS PAC ID: 4183888738 Enrollment ID: I20130627000177 |
| Provider Name | Shaheen Alanee |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1326231390 PECOS PAC ID: 6800051582 Enrollment ID: I20130812000254 |
| Provider Name | April Parker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821226408 PECOS PAC ID: 3870736903 Enrollment ID: I20130826000078 |
| Provider Name | Stacy R Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538593470 PECOS PAC ID: 0143454066 Enrollment ID: I20131009000306 |
| Provider Name | Christopher D Stone |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1750356614 PECOS PAC ID: 3072589068 Enrollment ID: I20131111001500 |
| Provider Name | Manjinder Kaur Brar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174789663 PECOS PAC ID: 8325189384 Enrollment ID: I20131121001755 |
| Provider Name | Paul S Havrilka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801071543 PECOS PAC ID: 8921236829 Enrollment ID: I20140123001132 |
| Provider Name | Karla R Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275954778 PECOS PAC ID: 0244461382 Enrollment ID: I20140402001952 |
| Provider Name | Jeffrey Craver |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1629035886 PECOS PAC ID: 0749358802 Enrollment ID: I20140514001002 |
| Provider Name | Avinash M Murthy |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1528228624 PECOS PAC ID: 9335364181 Enrollment ID: I20140710001715 |
| Provider Name | Brandy Michele Byrd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902217540 PECOS PAC ID: 6305061904 Enrollment ID: I20140715000496 |
| Provider Name | Binh T Nguyen |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1093933665 PECOS PAC ID: 3476628421 Enrollment ID: I20140805001009 |
| Provider Name | Jack Hall |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1558337857 PECOS PAC ID: 6709861743 Enrollment ID: I20141118001227 |
| Provider Name | Katherine J Robbins |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1073792727 PECOS PAC ID: 6002094539 Enrollment ID: I20141212000567 |
| Provider Name | Faizan A Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194022541 PECOS PAC ID: 5890017222 Enrollment ID: I20141213000193 |
| Provider Name | Anne Leslie Kramer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326441478 PECOS PAC ID: 0345564787 Enrollment ID: I20150113002191 |
| Provider Name | Stella C Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437556800 PECOS PAC ID: 2365767803 Enrollment ID: I20150204001918 |
| Provider Name | Dawn Mckenzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215288683 PECOS PAC ID: 5092966754 Enrollment ID: I20150217002186 |
| Provider Name | Yehia K Khoga |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063400810 PECOS PAC ID: 3072838978 Enrollment ID: I20150218000863 |
| Provider Name | Mary M Henry |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1144283136 PECOS PAC ID: 7719140888 Enrollment ID: I20150409000928 |
| Provider Name | Marco V Baquero |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730298902 PECOS PAC ID: 4183512007 Enrollment ID: I20150415000409 |
| Provider Name | Carlos Elias Garcia |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1942216890 PECOS PAC ID: 2163417262 Enrollment ID: I20150504001901 |
| Provider Name | Poornima Pandellapalli |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1205933850 PECOS PAC ID: 8224129655 Enrollment ID: I20150512002975 |
| Provider Name | Tracie E Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508258476 PECOS PAC ID: 0648581371 Enrollment ID: I20150622000984 |
| Provider Name | Avani Changela |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1740582246 PECOS PAC ID: 6901118140 Enrollment ID: I20150701001025 |
| Provider Name | Mohammed Ali Al-zoubaidi |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1063606432 PECOS PAC ID: 4587976683 Enrollment ID: I20150702000357 |
| Provider Name | Melanie Cross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093197410 PECOS PAC ID: 1254644768 Enrollment ID: I20150713001938 |
| Provider Name | Naga Sirikonda |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1396919544 PECOS PAC ID: 4082927413 Enrollment ID: I20150714002752 |
| Provider Name | Lawrence F Kuhn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063522464 PECOS PAC ID: 3971798406 Enrollment ID: I20150727001221 |
| Provider Name | Gloria N Abenes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316000219 PECOS PAC ID: 4880793207 Enrollment ID: I20150727001356 |
| Provider Name | Jeffrey Larson |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1013166990 PECOS PAC ID: 4082857594 Enrollment ID: I20150730011958 |
| Provider Name | Karen Markeisha Sobers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306133012 PECOS PAC ID: 4880908177 Enrollment ID: I20150730012446 |
| Provider Name | Keri A Douglas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104201714 PECOS PAC ID: 0547575599 Enrollment ID: I20150819008737 |
| Provider Name | Sara B Rubenacker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1023304094 PECOS PAC ID: 8224344957 Enrollment ID: I20150826001280 |
| Provider Name | Rita Mukerji |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1023218807 PECOS PAC ID: 6305961673 Enrollment ID: I20150831002407 |
| Provider Name | Tatiana Ramirez Dominguez |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1043443377 PECOS PAC ID: 6709058563 Enrollment ID: I20150923000965 |
| Provider Name | Sarah Starnes |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1215165410 PECOS PAC ID: 3274853825 Enrollment ID: I20151001003213 |
| Provider Name | Allan S Goldstein |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1871646554 PECOS PAC ID: 8628055373 Enrollment ID: I20151007001142 |
| Provider Name | Stephanie D Gordon |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1174992127 PECOS PAC ID: 5395053557 Enrollment ID: I20151007003133 |
| Provider Name | Heather R Beyers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962870790 PECOS PAC ID: 8820307937 Enrollment ID: I20151012000666 |
| Provider Name | Wei Lin |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1386621654 PECOS PAC ID: 1456383256 Enrollment ID: I20160120002741 |
| Provider Name | Sophia S Hom |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1053394676 PECOS PAC ID: 0749231033 Enrollment ID: I20160215000869 |
| Provider Name | Amit Wasudeo Bhandarkar |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1962711937 PECOS PAC ID: 3678753720 Enrollment ID: I20160412001675 |
| Provider Name | Tamara E Copeland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295192805 PECOS PAC ID: 3971802216 Enrollment ID: I20160509000753 |
| Provider Name | Angela L Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639532609 PECOS PAC ID: 1557651544 Enrollment ID: I20160603000047 |
| Provider Name | Donna A Jewell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649626144 PECOS PAC ID: 1254622178 Enrollment ID: I20160624000225 |
| Provider Name | Katherine E Schwetye |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1962780155 PECOS PAC ID: 4385934983 Enrollment ID: I20160630000246 |
| Provider Name | Hemant Sindhu |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1790057123 PECOS PAC ID: 6901113158 Enrollment ID: I20160712000181 |
| Provider Name | Gopinath Gorthy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831534460 PECOS PAC ID: 1759687353 Enrollment ID: I20160718000704 |
| Provider Name | Varun Puri |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1336366087 PECOS PAC ID: 5395898241 Enrollment ID: I20160802001433 |
| Provider Name | Musheni Nsa |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1679863369 PECOS PAC ID: 6507150489 Enrollment ID: I20160816001498 |
| Provider Name | Shivi Sivananthi Siva |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548697964 PECOS PAC ID: 7911223508 Enrollment ID: I20160818001805 |
| Provider Name | Gregory B Jasinski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164735403 PECOS PAC ID: 0345495693 Enrollment ID: I20160831001772 |
| Provider Name | Bryan F Meyers |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1275551913 PECOS PAC ID: 9335284074 Enrollment ID: I20160901000175 |
| Provider Name | Samantha A Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215481924 PECOS PAC ID: 6608162433 Enrollment ID: I20160906000144 |
| Provider Name | Martha E Bidiuc |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508918095 PECOS PAC ID: 7810147493 Enrollment ID: I20160920002159 |
| Provider Name | Sharon S Szatkowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952517831 PECOS PAC ID: 5395797146 Enrollment ID: I20160928002110 |
| Provider Name | Alicia J Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437506722 PECOS PAC ID: 4981982444 Enrollment ID: I20161103001573 |
| Provider Name | Nicole L Vetter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821548207 PECOS PAC ID: 0143508549 Enrollment ID: I20161104000661 |
| Provider Name | Misty Dawn Wernsman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144771692 PECOS PAC ID: 5395024301 Enrollment ID: I20161115002180 |
| Provider Name | Heidi V Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629510581 PECOS PAC ID: 4284913716 Enrollment ID: I20161128000465 |
| Provider Name | Kiran Kumar R Mangalpally |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1558518209 PECOS PAC ID: 1254510878 Enrollment ID: I20170106000806 |
| Provider Name | Jasdeep Dalawari |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1215986807 PECOS PAC ID: 1759275167 Enrollment ID: I20170130000865 |
| Provider Name | Deanne M Perez Meskil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780127258 PECOS PAC ID: 5294018693 Enrollment ID: I20170209000588 |
| Provider Name | Giuseppe Gioia |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1932188729 PECOS PAC ID: 6103894514 Enrollment ID: I20170306001974 |
| Provider Name | David Goldberg |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1053397810 PECOS PAC ID: 1759346091 Enrollment ID: I20170315001950 |
| Provider Name | Carlos Sierra-rodriguez |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1700865268 PECOS PAC ID: 7618944588 Enrollment ID: I20170316001222 |
| Provider Name | Bhagat K Reddy |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1144225293 PECOS PAC ID: 1850367558 Enrollment ID: I20170323000176 |
| Provider Name | Jamie R Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336680925 PECOS PAC ID: 8426335092 Enrollment ID: I20170509000489 |
| Provider Name | Yogesh R Patel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1235157876 PECOS PAC ID: 0547262818 Enrollment ID: I20170524002027 |
| Provider Name | Keki Balsara |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1942467642 PECOS PAC ID: 3375792070 Enrollment ID: I20170607003106 |
| Provider Name | Rahul Sharma |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1447505953 PECOS PAC ID: 3072834704 Enrollment ID: I20170612001713 |
| Provider Name | Abdulmonam A Ali |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1396026506 PECOS PAC ID: 4082918263 Enrollment ID: I20170613000176 |
| Provider Name | Ronald Scott Sokovich |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1396796074 PECOS PAC ID: 3870552250 Enrollment ID: I20170629001485 |
| Provider Name | Hasan Al Janabi |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1255530119 PECOS PAC ID: 8426228008 Enrollment ID: I20170705001400 |
| Provider Name | Andrew Navindra Latchman |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1184060832 PECOS PAC ID: 5193023810 Enrollment ID: I20171002000919 |
| Provider Name | Michael P Delacruz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629232087 PECOS PAC ID: 0042480758 Enrollment ID: I20171010001181 |
| Provider Name | Jed-sian Cheng |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1508021544 PECOS PAC ID: 6507000171 Enrollment ID: I20171020001914 |
| Provider Name | Nicole Marie Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982123899 PECOS PAC ID: 9830455906 Enrollment ID: I20171106001078 |
| Provider Name | Roxanna E Stevens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366951436 PECOS PAC ID: 2961761226 Enrollment ID: I20180111001295 |
| Provider Name | Kelli M Mowrer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417468190 PECOS PAC ID: 7618236597 Enrollment ID: I20180123000835 |
| Provider Name | Megan M Zimmerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740795194 PECOS PAC ID: 1658632153 Enrollment ID: I20180226000506 |
| Provider Name | Randy Metcalf |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1073506648 PECOS PAC ID: 4486685765 Enrollment ID: I20180322000830 |
| Provider Name | Adam C Ring |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1205102217 PECOS PAC ID: 0042594863 Enrollment ID: I20180322002024 |
| Provider Name | Alicia A Yaeger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861911026 PECOS PAC ID: 6608139589 Enrollment ID: I20180405001056 |
| Provider Name | Janell Tabora |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811334410 PECOS PAC ID: 7113168477 Enrollment ID: I20180409000025 |
| Provider Name | Darla J Allan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215184635 PECOS PAC ID: 7911068747 Enrollment ID: I20180524001286 |
| Provider Name | Victoria Marie Koch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336656537 PECOS PAC ID: 5496010704 Enrollment ID: I20180606003520 |
| Provider Name | Shahir Okhovat-ghahfarokhi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1194134080 PECOS PAC ID: 5193070969 Enrollment ID: I20180619001747 |
| Provider Name | Alberto Nava Vargas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669963765 PECOS PAC ID: 3971854324 Enrollment ID: I20180924001890 |
| Provider Name | Erica Lynne Ibendahl |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1134483514 PECOS PAC ID: 5698909885 Enrollment ID: I20180926000543 |
| Provider Name | Akhila Ramayapally |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1356773485 PECOS PAC ID: 5991057895 Enrollment ID: I20181003002915 |
| Provider Name | Dana L Trame |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538649967 PECOS PAC ID: 7214280338 Enrollment ID: I20181018003163 |
| Provider Name | Tyler Wishau |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1144649856 PECOS PAC ID: 5698047231 Enrollment ID: I20181031001161 |
| Provider Name | Lee G Beckwith |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1790761609 PECOS PAC ID: 3577534122 Enrollment ID: I20181112001900 |
| Provider Name | Vinit Vinayak Patil |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1447696828 PECOS PAC ID: 4880996347 Enrollment ID: I20181221000668 |
| Provider Name | Nishant Poddar |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1124387675 PECOS PAC ID: 9638324551 Enrollment ID: I20190111000665 |
| Provider Name | Amy Blandford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598240145 PECOS PAC ID: 3476899337 Enrollment ID: I20190114001949 |
| Provider Name | Marvin Antonio Duque |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1659520823 PECOS PAC ID: 0749337368 Enrollment ID: I20190128003509 |
| Provider Name | Richard J Ernst |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508177007 PECOS PAC ID: 5799917613 Enrollment ID: I20190201000152 |
| Provider Name | Robert W Santa-cruz |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1508816869 PECOS PAC ID: 8123004249 Enrollment ID: I20190204000010 |
| Provider Name | Birju Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699018317 PECOS PAC ID: 1557608338 Enrollment ID: I20190218001452 |
| Provider Name | Ashley C Hofer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316419252 PECOS PAC ID: 1153660576 Enrollment ID: I20190301002356 |
| Provider Name | Jakeyla Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215492491 PECOS PAC ID: 1052650066 Enrollment ID: I20190307003200 |
| Provider Name | Marc Louis Sabatino |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1689810855 PECOS PAC ID: 0648572453 Enrollment ID: I20190412000138 |
| Provider Name | Murugavel Muthusamy |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1467420760 PECOS PAC ID: 1850362062 Enrollment ID: I20190418000546 |
| Provider Name | Dinesh Telang |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1265498117 PECOS PAC ID: 9537055090 Enrollment ID: I20190507000280 |
| Provider Name | Moungar Elton Cooper |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1013208958 PECOS PAC ID: 4284936857 Enrollment ID: I20190513001006 |
| Provider Name | Jessica Lynn Chapman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316454085 PECOS PAC ID: 3971846957 Enrollment ID: I20190514002069 |
| Provider Name | Olufeyisayo Jokotola Taiwo |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194108712 PECOS PAC ID: 2466786009 Enrollment ID: I20190701002450 |
| Provider Name | Kevin Krishna Birusingh |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1497915300 PECOS PAC ID: 2567605215 Enrollment ID: I20190709001740 |
| Provider Name | Louis Clarence Remynse |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1649280793 PECOS PAC ID: 2769477991 Enrollment ID: I20190905001082 |
| Provider Name | Richard E Chernecky |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1437210341 PECOS PAC ID: 2961551353 Enrollment ID: I20190905003281 |
| Provider Name | Danilo Achy Martins |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1881031144 PECOS PAC ID: 5294025854 Enrollment ID: I20190925002459 |
| Provider Name | Fariahh Fazil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053954503 PECOS PAC ID: 8527490598 Enrollment ID: I20191112002957 |
| Provider Name | Hayley Harris Martins |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023375433 PECOS PAC ID: 0749596609 Enrollment ID: I20191120001320 |
| Provider Name | Kelly R Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912553892 PECOS PAC ID: 9234220989 Enrollment ID: I20191224000248 |
| Provider Name | Gregory Szych |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1841268521 PECOS PAC ID: 4688655467 Enrollment ID: I20200122000120 |
| Provider Name | Annie Rae Lowery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407418619 PECOS PAC ID: 7810323565 Enrollment ID: I20200129000504 |
| Provider Name | Elsayed Abo-salem |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1629207477 PECOS PAC ID: 7719116490 Enrollment ID: I20200211001246 |
| Provider Name | Ravi Kamepalli |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1669464681 PECOS PAC ID: 1658404652 Enrollment ID: I20200227001110 |
| Provider Name | Patricia Teschke |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1790045417 PECOS PAC ID: 0446550909 Enrollment ID: I20200320000348 |
| Provider Name | Jeffery Joseph Dorociak |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1407805328 PECOS PAC ID: 0345231973 Enrollment ID: I20200326002530 |
| Provider Name | Angela Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427545086 PECOS PAC ID: 9436414984 Enrollment ID: I20200409000836 |
| Provider Name | Travis Dum |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1578829958 PECOS PAC ID: 7214233766 Enrollment ID: I20200424000625 |
| Provider Name | Kerry Lynn Pitchford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205455763 PECOS PAC ID: 0143641126 Enrollment ID: I20200529000309 |
| Provider Name | Shannon D Parks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598308389 PECOS PAC ID: 7315369782 Enrollment ID: I20200612002006 |
| Provider Name | Chandra Kanth Chaturvedula |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1215311683 PECOS PAC ID: 8729379193 Enrollment ID: I20200708001819 |
| Provider Name | Amber Lynn Wennerstrom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144844572 PECOS PAC ID: 5698199867 Enrollment ID: I20200721001970 |
| Provider Name | Scherrie Lynn Medina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417573734 PECOS PAC ID: 3173949773 Enrollment ID: I20200813000810 |
| Provider Name | Ashley Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386191393 PECOS PAC ID: 4688907736 Enrollment ID: I20200825001880 |
| Provider Name | Robert Schergen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1023469277 PECOS PAC ID: 6305189762 Enrollment ID: I20200915001278 |
| Provider Name | Maria Riaz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245751940 PECOS PAC ID: 5294074944 Enrollment ID: I20201005002063 |
| Provider Name | Vishnu Mohan |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1497138838 PECOS PAC ID: 4587084363 Enrollment ID: I20201016000112 |
| Provider Name | Kurtis Stewart |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306004676 PECOS PAC ID: 9739305699 Enrollment ID: I20201019000372 |
| Provider Name | Erica Prater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679118616 PECOS PAC ID: 2466889191 Enrollment ID: I20201026001251 |
| Provider Name | Emir Barbaros Safak Guven |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1366493181 PECOS PAC ID: 9133113582 Enrollment ID: I20210105001230 |
| Provider Name | Lara A Penn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538406954 PECOS PAC ID: 5698917979 Enrollment ID: I20210126003256 |
| Provider Name | Dimi D Resch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417591173 PECOS PAC ID: 4688088719 Enrollment ID: I20210201000156 |
| Provider Name | Kristin E Grossman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861884264 PECOS PAC ID: 0749501906 Enrollment ID: I20210208000334 |
| Provider Name | Jennifer Lynn Starr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154917698 PECOS PAC ID: 7911131453 Enrollment ID: I20210219000024 |
| Provider Name | Linda G Boulware |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063000669 PECOS PAC ID: 2769897701 Enrollment ID: I20210224002422 |
| Provider Name | Nicole Brandi Pedtke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326664111 PECOS PAC ID: 5799190609 Enrollment ID: I20210225003198 |
| Provider Name | Rafael E Coplin Reynoso |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1427095702 PECOS PAC ID: 9133177637 Enrollment ID: I20210304002207 |
| Provider Name | Kathleen M Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487195251 PECOS PAC ID: 5496022824 Enrollment ID: I20210510000496 |
| Provider Name | Dara Josiah-howze |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063407278 PECOS PAC ID: 3577597699 Enrollment ID: I20210514000270 |
| Provider Name | Joseph Platz |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1699074336 PECOS PAC ID: 3375846603 Enrollment ID: I20210601002244 |
| Provider Name | Allison R. Thorn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952340317 PECOS PAC ID: 7911929484 Enrollment ID: I20210624003421 |
| Provider Name | Mohammad El-atoum |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1871947515 PECOS PAC ID: 1153668587 Enrollment ID: I20210706002039 |
| Provider Name | Chloe Marie El-atoum |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619409042 PECOS PAC ID: 7315284486 Enrollment ID: I20210808000038 |
| Provider Name | Andrea Marie Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316610256 PECOS PAC ID: 1153726872 Enrollment ID: I20210818003310 |
| Provider Name | Ilka Nazario |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992755896 PECOS PAC ID: 6608805866 Enrollment ID: I20210917000793 |
| Provider Name | Jennifer Testerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548205008 PECOS PAC ID: 6305738667 Enrollment ID: I20211001000036 |
| Provider Name | Heather Keith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699156372 PECOS PAC ID: 5698070621 Enrollment ID: I20211015000147 |
| Provider Name | Kimberly Rene Claffey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194495424 PECOS PAC ID: 9830588086 Enrollment ID: I20211110001079 |
| Provider Name | Hector Alejandro Preti |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1861484628 PECOS PAC ID: 3476540634 Enrollment ID: I20211117002920 |
| Provider Name | Camille Deanna Greider |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699319004 PECOS PAC ID: 5890120356 Enrollment ID: I20211119000575 |
| Provider Name | Ashish Ramesh Thakkar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538456124 PECOS PAC ID: 3274758263 Enrollment ID: I20211220001020 |
| Provider Name | Zhanna O Goldkamp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457852204 PECOS PAC ID: 9537595913 Enrollment ID: I20220301001153 |
| Provider Name | Christina Kay Frymire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922750785 PECOS PAC ID: 1153716188 Enrollment ID: I20220309002797 |
| Provider Name | Trisha Ruby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801447032 PECOS PAC ID: 6800229865 Enrollment ID: I20220330001564 |
| Provider Name | Ahmad Abou Leila |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1861741126 PECOS PAC ID: 4183993546 Enrollment ID: I20220518001884 |
| Provider Name | Abbas Omais |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1699748046 PECOS PAC ID: 9133213226 Enrollment ID: I20220607000091 |
| Provider Name | Rachel Ellnetta Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205576956 PECOS PAC ID: 0446638092 Enrollment ID: I20220609002401 |
| Provider Name | Fariba Dayhim |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1790941805 PECOS PAC ID: 2466510235 Enrollment ID: I20220810001927 |
| Provider Name | Helen R Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295253359 PECOS PAC ID: 9830459379 Enrollment ID: I20220927000626 |
| Provider Name | Rachelle Ranae May |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396467809 PECOS PAC ID: 6507232899 Enrollment ID: I20221011001482 |
| Provider Name | Vishnu Raj Kumar Mani |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1174964951 PECOS PAC ID: 3476956095 Enrollment ID: I20221016000028 |
| Provider Name | Michael S James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659004430 PECOS PAC ID: 5597131524 Enrollment ID: I20221017002058 |
| Provider Name | Soisangvane Wingard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922370899 PECOS PAC ID: 6507020989 Enrollment ID: I20230217002389 |
| Provider Name | Ricardo Crisostomo |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1679533756 PECOS PAC ID: 9436177490 Enrollment ID: I20230421001317 |
| Provider Name | Marilyn Kline |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1629027586 PECOS PAC ID: 8325050933 Enrollment ID: I20230426001682 |
| Provider Name | Shelby Guthrie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679278352 PECOS PAC ID: 5698869956 Enrollment ID: I20230510001915 |
| Provider Name | Katherine Scodary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376047704 PECOS PAC ID: 5890059877 Enrollment ID: I20230627001730 |
| Provider Name | Chingleput Ranganathan |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1720063761 PECOS PAC ID: 4789671199 Enrollment ID: I20230630003257 |
| Provider Name | Robert Cuff |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1003854415 PECOS PAC ID: 6507827300 Enrollment ID: I20230719002901 |
| Provider Name | Alexander Seger |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457913279 PECOS PAC ID: 1355671348 Enrollment ID: I20230720002871 |
| Provider Name | Anupam Gupta |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1467893412 PECOS PAC ID: 2062718570 Enrollment ID: I20231013000751 |
| Provider Name | Amanda Grigoli |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1518462340 PECOS PAC ID: 4880049394 Enrollment ID: I20231018000682 |
| Provider Name | Katelyn Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669154670 PECOS PAC ID: 1052766599 Enrollment ID: I20231018002156 |
| Provider Name | Kathern Joan Norman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003509530 PECOS PAC ID: 9436507605 Enrollment ID: I20231128003369 |
| Provider Name | Amanda B Gordon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780103143 PECOS PAC ID: 1850666462 Enrollment ID: I20240216000150 |
| Provider Name | Lavada Rainier Simpson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780452235 PECOS PAC ID: 9234573288 Enrollment ID: I20240216003798 |
| Provider Name | Ronald Innerfield |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1063457950 PECOS PAC ID: 0446222772 Enrollment ID: I20240311000416 |
| Provider Name | Brooke Willows |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1457880353 PECOS PAC ID: 8921376161 Enrollment ID: I20240401000127 |
Deaconess Il Specialty 4117 Water Tower Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4117 S Water Tower Pl Ste C, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 | |
Anderson Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3505 Broadway St, Mount Vernon, IL 62864 Phone: 618-244-7788 Fax: 618-244-9330 | |
Deaconess Illinois Clinic, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4105 N Water Tower Pl, Mount Vernon, IL 62864 Phone: 812-450-6815 | |
Deaconess Illinois Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4117 S Water Tower Pl, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 | |
Deaconess Illinois Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4113 S Water Tower Pl, Mount Vernon, IL 62864 Phone: 618-241-9071 Fax: 618-241-9079 | |
King City Physician Company, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4117 S Water Tower Pl, Suite C, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 | |
Crossroads Physician Corp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 209 Crossroads Pl, Suite 140, Mount Vernon, IL 62864 Phone: 618-241-7207 Fax: 618-241-7210 |