Ashley Michelle Tyler (NPI# 1306329594, PAC ID# 0345593513) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1306329594 |
| PAC ID by PECOS | 0345593513 |
| Professional Enrollment ID | I20181106000516 |
| Full Name | Ashley Michelle Tyler |
| Organization Legal Name | GRANITE CITY CLINIC CORP |
| Address |
602 Farrish St Madison IL 62060-1567 |
| Phone Number | 6183440248 |
| Gender | F |
| Graduation Year | 2018 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 6406747906 |
| Number of Group Practice Members | 29 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140125 | GATEWAY REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 602 Farrish St, Madison, IL 62060-1567 | 6183440248 | GRANITE CITY CLINIC CORP |
| Organization Legal Name | GRANITE CITY CLINIC CORP |
| Physicians | 26 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Victoria A Cullen | Clinical Social Worker | Granite City Clinic Corp | 2100 Madison Ave, Suite 201, Granite City, IL 62040-4713 |
| Hasan Al-janabi | Internal Medicine | Granite City Clinic Corp | 1261 University Dr E, Edwardsville, IL 62025-5587 |
| Emily Cottrell | Nurse Practitioner | Granite City Clinic Corp | 4273 S State Route 159, Second Floor, Glen Carbon, IL 62034 |
| Adam Joseph Rammacher | Podiatry | Granite City Clinic Corp | 1261 University Dr A, Edwardsville, IL 62025-5587 |
| Billie L Vincent | Nurse Practitioner | Granite City Clinic Corp | 220 E Us Hwy 40, Troy, IL 62294-2201 |
| Kelly R Murray | Certified Nurse Midwife (cnm) | Granite City Clinic Corp | 2246s State Route 157, Suite 100, Glen Carbon, IL 62034-1717 |
| Stephen Kent Burger | Neurology | Granite City Clinic Corp | 1261 University Dr, Edwardsville, IL 62025-5586 |
| Serge Marinkovic | Urology | Granite City Clinic Corp | 2100 Madison Ave, Suite 201, Granite City, IL 62040-4713 |
| Runda A El Khatib | Family Medicine | Granite City Clinic Corp | 2044 Madison Ave, Suite 27, Granite City, IL 62040-4661 |
| Megan Danielle Wood | Internal Medicine | Granite City Clinic Corp | 2100 Madison Ave, Suite 201, Granite City, IL 62040-4713 |
| Street Address |
602 FARRISH ST |
| City | MADISON |
| State | IL |
| Zip | 62060-1567 |
| City | MADISON |
| Zip Code | 62060 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | MADISON + NURSE PRACTITIONER |
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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.