Kelly Nicole Bray (NPI# 1043525785, PAC ID# 5991951477) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is EMERGENCY MEDICINE.
| Nation Provider ID (NPI) | 1043525785 |
| PAC ID by PECOS | 5991951477 |
| Professional Enrollment ID | I20120816000406 |
| Full Name | Kelly Nicole Bray |
| Organization Legal Name | EPSS LLC - CENTRAL SERIES |
| Address |
600 S 13th St Pekin IL 61554-4936 |
| Phone Number | 3093471151 |
| Gender | F |
| Medical School | PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE |
| Graduation Year | 2008 |
| Primary Specialty | EMERGENCY MEDICINE |
| Group Practice PAC ID | 6204192016 |
| Number of Group Practice Members | 30 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140120 | PEKIN MEMORIAL HOSPITAL |
| 140110 | OTTAWA REGIONAL HOSPITAL DBA OSF SAINT ELIZABETH MDL CTR |
| 151305 | PULASKI MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 600 S 13th St, Pekin, IL 61554-4936 | 3093471151 | EPSS LLC - CENTRAL SERIES |
| 616 E 13th St, Winamac, IN 46996-1117 | 5749462100 | WINAMAC EMERGENCY PHYSICIANS LLC |
| Organization Legal Name | EPSS LLC - CENTRAL SERIES |
| Physicians | 15 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Dwayne P Bernard | Emergency Medicine | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Andrew W Walter | Emergency Medicine | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Ashley R Marmon | Nurse Practitioner | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Eric D Mohr | Emergency Medicine | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Tiereny N Minassian | Nurse Practitioner | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Cory M Sharp | Physician Assistant | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Troy S Cutler | Emergency Medicine | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Chad M Conklin | Family Medicine | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Kenneth E Carpenter | Emergency Medicine | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Michelle A Kallenborn | Emergency Medicine | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Street Address |
600 S 13TH ST |
| City | PEKIN |
| State | IL |
| Zip | 61554-4936 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Dwayne P Bernard | Emergency Medicine | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Sandra M Krahn | Certified Registered Nurse Anesthetist (crna) | Methodist Medical Center of Illinois | 600 S 13th St, Pekin, IL 61554-4936 |
| Nupoor D Tillu | Anesthesiology | Methodist Medical Center of Illinois | 600 S 13th St, Pekin, IL 61554-4936 |
| Paul A Siebert | General Surgery | Pekin Prohealth Inc | 600 S 13th St, Pekin, IL 61554-4936 |
| Andrew W Walter | Emergency Medicine | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Indira Danturti | Anesthesiology | Methodist Medical Center of Illinois | 600 S 13th St, Pekin, IL 61554-4936 |
| Ashley R Marmon | Nurse Practitioner | Epss LLC - Central Series | 600 S 13th St, Pekin, IL 61554-4936 |
| Angela M Brown | Certified Registered Nurse Anesthetist (crna) | Methodist Medical Center of Illinois | 600 S 13th St, Pekin, IL 61554-4936 |
| Maytee Boonyapredee | Internal Medicine | Pekin Prohealth Inc | 600 S 13th St, Pekin, IL 61554-4936 |
| Lily Tran | Pathology | Peoria Tazewell Pathology Group, S.c. | 600 S 13th St, Pekin, IL 61554-4936 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Brendon J Johnson | Optometry | 2611 Broadway St, Pekin, IL 61554-2501 | |
| Douglas C Harrington | Obstetrics/gynecology | 2709 Broadway St, Pekin, IL 61554-2676 | |
| Raymond Rs Heyde | Ophthalmology | Heyde Eye Center S.c | 111 N 4th St, Pekin, IL 61554-3248 |
| William E Fish | Optometry | Heyde Eye Center S.c | 111 N 4th St, Pekin, IL 61554-3248 |
| Jerry B Witt | Chiropractic | 611 Margaret St, Pekin, IL 61554-3355 | |
| Jijun Liu | Medical Oncology | Oncology Hematology Associates of Central Illinois PC | 1641 Broadway St, Pekin, IL 61554-3805 |
| Lindsey Lorraine Grys | Nurse Practitioner | Oncology Hematology Associates of Central Illinois PC | 1641 Broadway St, Pekin, IL 61554-3805 |
| Nicholas L Warnecke | Physician Assistant | Methodist Medical Center of Illinois | 1800 Broadway St, Pekin, IL 61554-3822 |
| Pawan Sarda | Cardiovascular Disease (cardiology) | Methodist Medical Center of Illinois | 1800 Broadway St, Pekin, IL 61554-3822 |
| Tahir Ilahi | Cardiovascular Disease (cardiology) | Methodist Medical Center of Illinois | 1800 Broadway St, Pekin, IL 61554-3822 |
| Find all physicians in zip 61554 | |||
| City | PEKIN |
| Zip Code | 61554 |
| Specialty | EMERGENCY MEDICINE |
| City + Specialty | PEKIN + EMERGENCY MEDICINE |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.