| St Anthony Physician Group | |
|
1102 W Macarthur St Shawnee OK 74804-1743 | |
| (405) 878-8110 | |
| (405) 878-8101 |
| Full Name | St Anthony Physician Group |
|---|---|
| Speciality | Surgery |
| Location | 1102 W Macarthur St, Shawnee, Oklahoma |
| Authorized Official Name and Position | Charles Skillings (PRESIDENT) |
| Authorized Official Contact | 4058788110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Anthony Physician Group 1102 W Macarthur St Shawnee OK 74804-1743 Ph: (405) 878-8110 | St Anthony Physician Group 1102 W Macarthur St Shawnee OK 74804-1743 Ph: (405) 878-8110 |
| NPI Number | 1619260411 |
|---|---|
| Provider Enumeration Date | 05/26/2011 |
| Last Update Date | 09/25/2012 |
| Medicare PECOS PAC ID | 1052567328 |
|---|---|
| Medicare Enrollment ID | O20121015000218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619260411 | NPI | - | NPPES |
| Provider Name | Janet Sue Pasquali Bowers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184681694 PECOS PAC ID: 5799679528 Enrollment ID: I20040211001060 |
| Provider Name | Elizabeth Wickersham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992706048 PECOS PAC ID: 8224924337 Enrollment ID: I20040228000307 |
| Provider Name | Robert S Stewart |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649273939 PECOS PAC ID: 9739076415 Enrollment ID: I20040408000036 |
| Provider Name | Gaynell Schieber Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114925781 PECOS PAC ID: 1355336769 Enrollment ID: I20040415001269 |
| Provider Name | David Lewis Hadley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023070679 PECOS PAC ID: 8527951961 Enrollment ID: I20040504000347 |
| Provider Name | Wendell L Richards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588656292 PECOS PAC ID: 1355330077 Enrollment ID: I20040520001589 |
| Provider Name | John H Summers |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1699736363 PECOS PAC ID: 8426031352 Enrollment ID: I20040610001334 |
| Provider Name | Steven G Danley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124193255 PECOS PAC ID: 3274513742 Enrollment ID: I20040723001062 |
| Provider Name | Kenneth T Darvin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427021450 PECOS PAC ID: 0345205142 Enrollment ID: I20041122000166 |
| Provider Name | Kristy J Yates |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1215964044 PECOS PAC ID: 8729043062 Enrollment ID: I20041129000086 |
| Provider Name | Kevin D Johnson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1598792327 PECOS PAC ID: 0042263337 Enrollment ID: I20050418000480 |
| Provider Name | Troy R Norred |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1780689844 PECOS PAC ID: 5991776270 Enrollment ID: I20050419001496 |
| Provider Name | Michael Brian Huff |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1508887027 PECOS PAC ID: 2567472590 Enrollment ID: I20060504000356 |
| Provider Name | Daniel S Matlock |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1992765838 PECOS PAC ID: 5496766834 Enrollment ID: I20060523000100 |
| Provider Name | Dwight L Thacker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1801865100 PECOS PAC ID: 0840299871 Enrollment ID: I20061220000285 |
| Provider Name | Robert W Rader |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669406062 PECOS PAC ID: 7517967565 Enrollment ID: I20061222000186 |
| Provider Name | Ryan K Aldrich |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760555130 PECOS PAC ID: 3577665306 Enrollment ID: I20070226000643 |
| Provider Name | Kimberly K Hanigar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609858331 PECOS PAC ID: 3173412566 Enrollment ID: I20070522000214 |
| Provider Name | Lara D Mashek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033239579 PECOS PAC ID: 7315997210 Enrollment ID: I20080402000433 |
| Provider Name | Sudhir K Gupta |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1437119286 PECOS PAC ID: 5092792184 Enrollment ID: I20080618000320 |
| Provider Name | Russell C Click |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144397571 PECOS PAC ID: 6507939865 Enrollment ID: I20080718000524 |
| Provider Name | Karyn S Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538139183 PECOS PAC ID: 1355363318 Enrollment ID: I20080826000052 |
| Provider Name | Martin Mcintosh |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1598723215 PECOS PAC ID: 2365331998 Enrollment ID: I20081125000137 |
| Provider Name | David Heon |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1811918691 PECOS PAC ID: 6507850443 Enrollment ID: I20090202000434 |
| Provider Name | Jason Whiteley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1669496725 PECOS PAC ID: 6901796838 Enrollment ID: I20090605000505 |
| Provider Name | Faisal Latif |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1770623068 PECOS PAC ID: 8325198211 Enrollment ID: I20090616000124 |
| Provider Name | Joseph C Rawdon |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1295973725 PECOS PAC ID: 7113070319 Enrollment ID: I20090805000791 |
| Provider Name | Scott C Gentry |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1952386633 PECOS PAC ID: 6709789316 Enrollment ID: I20091123000588 |
| Provider Name | Walid John Haddad |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1487600060 PECOS PAC ID: 5395713762 Enrollment ID: I20091211000425 |
| Provider Name | Jennifer L Fleck |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1013247378 PECOS PAC ID: 2961539952 Enrollment ID: I20100422001070 |
| Provider Name | Shanna Elaine Hampton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285899872 PECOS PAC ID: 4587797931 Enrollment ID: I20100805000295 |
| Provider Name | Travis D Thompson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1669791596 PECOS PAC ID: 3072637560 Enrollment ID: I20100907000440 |
| Provider Name | Filimon Hepolito Aguilar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790099984 PECOS PAC ID: 7719179803 Enrollment ID: I20101007000736 |
| Provider Name | Lauren Michele Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013109297 PECOS PAC ID: 6204015571 Enrollment ID: I20110119001090 |
| Provider Name | Kyle C Wooderson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1508095977 PECOS PAC ID: 1951585769 Enrollment ID: I20110401000614 |
| Provider Name | Sheryl M Ronne |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1225334089 PECOS PAC ID: 3678759347 Enrollment ID: I20110513000089 |
| Provider Name | Jess C Parker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1063688232 PECOS PAC ID: 9638242167 Enrollment ID: I20110531000699 |
| Provider Name | Matthew Kevin Miller |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1902195282 PECOS PAC ID: 3072791789 Enrollment ID: I20110629000081 |
| Provider Name | Christopher Keith Carpenter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184911554 PECOS PAC ID: 4486655776 Enrollment ID: I20110831000760 |
| Provider Name | Jodilyn Nicolas Caguioa-aquino |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649430737 PECOS PAC ID: 2769655687 Enrollment ID: I20111109000213 |
| Provider Name | Matthew J Jared |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205060183 PECOS PAC ID: 2264609916 Enrollment ID: I20120119000914 |
| Provider Name | Tara A Mccants |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1013221084 PECOS PAC ID: 1658548938 Enrollment ID: I20120127000481 |
| Provider Name | William R Saunders |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1992745509 PECOS PAC ID: 2163489956 Enrollment ID: I20120213000523 |
| Provider Name | Sunil Mathew |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1003990540 PECOS PAC ID: 2769511690 Enrollment ID: I20120529000280 |
| Provider Name | Mitchell Andrew Wolf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174608319 PECOS PAC ID: 7214925692 Enrollment ID: I20121015000154 |
| Provider Name | Erin S Allred |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356602700 PECOS PAC ID: 1850541400 Enrollment ID: I20121017000502 |
| Provider Name | Jolene M Rychtik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588094783 PECOS PAC ID: 5698906527 Enrollment ID: I20140318001498 |
| Provider Name | Allison Childers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245673573 PECOS PAC ID: 9638302987 Enrollment ID: I20140512001890 |
| Provider Name | Michael Jerome Brzozowski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861791022 PECOS PAC ID: 0345461489 Enrollment ID: I20141015000471 |
| Provider Name | Christine Dienna |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1720313901 PECOS PAC ID: 7012144082 Enrollment ID: I20151104001606 |
| Provider Name | Melissa D Barnes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932564432 PECOS PAC ID: 2961707914 Enrollment ID: I20160229002298 |
| Provider Name | Thomas R Leblanc |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1053440172 PECOS PAC ID: 3476589805 Enrollment ID: I20160524000672 |
| Provider Name | Aaron Hayes |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477007698 PECOS PAC ID: 7416243878 Enrollment ID: I20160912000096 |
| Provider Name | Sheri D'lynn Christian-armstrong |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1679996706 PECOS PAC ID: 6103104138 Enrollment ID: I20161026002177 |
| Provider Name | Ming Wu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356755979 PECOS PAC ID: 6800116344 Enrollment ID: I20170206002544 |
| Provider Name | Emily A Lamirand Griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023549664 PECOS PAC ID: 4486927142 Enrollment ID: I20170831003177 |
| Provider Name | Sailaja Adari |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1750532115 PECOS PAC ID: 9931329539 Enrollment ID: I20171024000887 |
| Provider Name | Manikumar Bheemarasetti |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1497986533 PECOS PAC ID: 8022384718 Enrollment ID: I20171025000160 |
| Provider Name | Mark E Bucher |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1295871283 PECOS PAC ID: 7012013998 Enrollment ID: I20180427001689 |
| Provider Name | Julie St John Mahaney |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1841679701 PECOS PAC ID: 5890002711 Enrollment ID: I20180703002125 |
| Provider Name | Eric Shane Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720562291 PECOS PAC ID: 3971856105 Enrollment ID: I20181105002258 |
| Provider Name | Brindha Gopala Krishnan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407208804 PECOS PAC ID: 1052645140 Enrollment ID: I20190624001808 |
| Provider Name | Mohan Mallikarjuna Edupuganti |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1164737490 PECOS PAC ID: 3173830981 Enrollment ID: I20191031002681 |
| Provider Name | Alexis Mendoza |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1710343272 PECOS PAC ID: 6800195025 Enrollment ID: I20210913001254 |
| Provider Name | Shawn Mayhew |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1164190310 PECOS PAC ID: 1456758002 Enrollment ID: I20210923002057 |
| Provider Name | Kseniya I Luz |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1457029605 PECOS PAC ID: 5991103640 Enrollment ID: I20211011000144 |
| Provider Name | Kelly Bacon |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1700844313 PECOS PAC ID: 6103710470 Enrollment ID: I20211101001542 |
| Provider Name | Srikrishna Vulava |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821301367 PECOS PAC ID: 7517108889 Enrollment ID: I20220228000945 |
| Provider Name | Ijeoma Arubaleze |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881081933 PECOS PAC ID: 2062768591 Enrollment ID: I20230422000151 |
| Provider Name | Joanne Elizabeth Lapetina |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1598723983 PECOS PAC ID: 5294732442 Enrollment ID: I20230509002658 |
| Provider Name | Igor Sister |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518149467 PECOS PAC ID: 4981787975 Enrollment ID: I20230511002035 |
| Provider Name | Walter N Ingram |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1417096389 PECOS PAC ID: 9133300817 Enrollment ID: I20230512002601 |
| Provider Name | Jason P Kimball |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326076548 PECOS PAC ID: 6709864135 Enrollment ID: I20230516003203 |
| Provider Name | Isma Nusrat Javed |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1285087536 PECOS PAC ID: 8022474634 Enrollment ID: I20230523002414 |
| Provider Name | Sheetal Haresh Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124132642 PECOS PAC ID: 7911969076 Enrollment ID: I20230608002184 |
| Provider Name | Cathy Marie O'neil |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1003955279 PECOS PAC ID: 6608834387 Enrollment ID: I20231107003857 |
| Provider Name | Irem Nasir |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1205018124 PECOS PAC ID: 9739261363 Enrollment ID: I20231204000708 |
| Provider Name | Dana Giarrizzi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497784680 PECOS PAC ID: 5395770044 Enrollment ID: I20231207003542 |
| Provider Name | Eugene Sangmuah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295703338 PECOS PAC ID: 4688568280 Enrollment ID: I20240304002449 |
| Provider Name | Ricci St. Jules |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578917613 PECOS PAC ID: 0547692980 Enrollment ID: I20240304003666 |
| Provider Name | Kerstin Womacks |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1801566153 PECOS PAC ID: 9335546571 Enrollment ID: I20240315002558 |
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