Dietra Leigh Angelly (NPI# 1902371313, PAC ID# 9931356276) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1902371313 |
| PAC ID by PECOS | 9931356276 |
| Professional Enrollment ID | I20190130001729 |
| Full Name | Dietra Leigh Angelly |
| Organization Legal Name | MEDICAL SERVICES RIC |
| Address |
201 S 14th St Herrin IL 62948-3631 |
| Phone Number | 6189422171 |
| Gender | F |
| Graduation Year | 2018 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 4880598978 |
| Number of Group Practice Members | 77 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140011 | SOUTHERN ILLINOIS HOSPITAL SERVICES DBA HERRIN HOSPITAL |
| 140164 | MEMORIAL HOSPITAL OF CARBONDALE |
| Address | Phone | Organization |
|---|---|---|
| 201 S 14th St, Herrin, IL 62948-3631 | 6189422171 | MEDICAL SERVICES RIC |
| 408 Lincoln Dr, Suite B, Herrin, IL 62948-3790 | 6183514980 | MEDICAL SERVICES RIC |
| Organization Legal Name | MEDICAL SERVICES RIC |
| Physicians | 73 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ryan Everett Doyel | Physical Medicine and Rehabilitation | Medical Services Ric | 5150 Capital Dr, Wheeling, IL 60090-7900 |
| Monica Rho | Physical Medicine and Rehabilitation | Medical Services Ric | 355 E Erie St, Chicago, IL 60611-3167 |
| Matthew C Oswald | Physical Medicine and Rehabilitation | Medical Services Ric | 345 E Superior St, Chicago, IL 60611-2654 |
| Phyllis M Muellner | Physical Medicine and Rehabilitation | Medical Services Ric | 1055 W 175th St, Suite 101, Homewood, IL 60430-4615 |
| Christopher D Reger | Physical Medicine and Rehabilitation | Medical Services Ric | 345 E Superior St, Chicago, IL 60611-2654 |
| Bonita Alexander | Physical Medicine and Rehabilitation | Medical Services Ric | 800 Biesterfield Rd, Elk Grove Village, IL 60007-3361 |
| Lynn Rose Vidakovic | Physical Medicine and Rehabilitation | Medical Services Ric | 355 E Erie St, Chicago, IL 60611-3167 |
| Santiago D Toledo Jr. | Physical Medicine and Rehabilitation | Medical Services Ric | 355 E Erie St, Chicago, IL 60611-3167 |
| Siena Elisa Nadal Ona | Physical Medicine and Rehabilitation | Medical Services Ric | 201 S 14th St, Herrin, IL 62948-3631 |
| Rachna Hajela Soriano | Physical Medicine and Rehabilitation | Medical Services Ric | 355 E Erie St, Chicago, IL 60611-3167 |
| Street Address |
201 S 14TH ST |
| City | HERRIN |
| State | IL |
| Zip | 62948-3631 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mohammed Lawan Gana Guba | Hospitalist | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
| Siena Elisa Nadal Ona | Physical Medicine and Rehabilitation | Medical Services Ric | 201 S 14th St, Herrin, IL 62948-3631 |
| Gerald W Mcclallen | Emergency Medicine | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
| John T Girardi | Emergency Medicine | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
| Harshavardhan R Tathireddy | Hospitalist | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
| John D Lundeberg | Certified Registered Nurse Anesthetist (crna) | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
| Chizor N Odibi | Hospitalist | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
| Keith Burchill | Physical Medicine and Rehabilitation | Medical Services Ric | 201 S 14th St, Herrin, IL 62948-3631 |
| Dabney Parker Stack | Clinical Social Worker | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
| Terrence P Glennon | Physical Medicine and Rehabilitation | Medical Services Ric | 201 S 14th St, Herrin, IL 62948-3631 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Trevor Crabtree | Optometry | Paul C Jacobs Trevor Crabtree Ptr | 223 N Park Ave, Herrin, IL 62948-3149 |
| Gerri Dyer | Nurse Practitioner | Southern Illinois Dermatology, PC | 220 N Park Ave, Suite 2, Herrin, IL 62948-3150 |
| Kelly D Chullen | Chiropractic | 120 E Herrin St, Total Health Chiropractic, Herrin, IL 62948-3163 | |
| Nova M Griffith | Psychologist, Clinical | 121 N 13th St, Suite 2, Herrin, IL 62948-3255 | |
| Motaz R Wraikat | Undersea and Hyperbaric Medicine | Southern Illinois Medical Services, Nfp | 315 S 14th St, Suite 3, Herrin, IL 62948-3601 |
| Sahitya Settypalli | Undersea and Hyperbaric Medicine | Southern Illinois Medical Services, Nfp | 315 S 14th St, Suite 3, Herrin, IL 62948-3601 |
| William Fix | Optometry | Marion Eye Centers Ltd | 321 S Park Ave, Herrin, IL 62948-3603 |
| Ellie Marie Bentley | General Surgery | Southern Illinois Medical Services, Nfp | 220 S Park Ave, Suite 3, Herrin, IL 62948-3612 |
| Nikita Chevalier | Urology | Southern Illinois Medical Services, Nfp | 220 S Park Ave, Suite 2, Herrin, IL 62948-3612 |
| Benjamin P Roose | General Surgery | Southern Illinois Medical Services, Nfp | 220 S Park Ave, Suite 3, Herrin, IL 62948-3612 |
| Find all physicians in zip 62948 | |||
| City | HERRIN |
| Zip Code | 62948 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | HERRIN + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Dietra Leigh Angelly.
| 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.