Jacob Colman Blakeman (NPI# 1760749261, PAC ID# 1052613122) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PODIATRY.
Nation Provider ID (NPI) | 1760749261 |
PAC ID by PECOS | 1052613122 |
Professional Enrollment ID | I20180220000537 |
Full Name | Jacob Colman Blakeman |
Organization Legal Name | GRANITE CITY CLINIC CORP |
Address |
12 Ginger Creek Pkwy Glen Carbon IL 62034-3502 |
Phone Number | 6189313338 |
Gender | M |
Graduation Year | 2012 |
Primary Specialty | PODIATRY |
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 |
140289 | ANDERSON HOSPITAL |
141336 | ST JOSEPH'S HOSPITAL |
Address | Phone | Organization |
---|---|---|
12 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 | 6189313338 | GRANITE CITY CLINIC CORP |
2100 Madison Ave, Suite 201, Granite City, IL 62040-4713 | 6187988400 | 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 |
Ashley Michelle Tyler | Nurse Practitioner | Granite City Clinic Corp | 602 Farrish St, Madison, IL 62060-1567 |
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 |
Street Address |
12 GINGER CREEK PKWY |
City | GLEN CARBON |
State | IL |
Zip | 62034-3502 |
Name | Specialty | Organization | Address |
---|---|---|---|
Walter A Mcdonald | Certified Registered Nurse Anesthetist (crna) | Aim Anesthesia LLC | 12 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 |
Rinki Mahay | Anesthesiology | Aim Anesthesia LLC | 12 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 |
Tong Zhu | Pain Management | Gateway Pain Center Inc | 12 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 |
Karrie Jean Clow | Certified Registered Nurse Anesthetist (crna) | Aim Anesthesia LLC | 12 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 |
James E Spalding | Certified Registered Nurse Anesthetist (crna) | Aim Anesthesia LLC | 12 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 |
Mohamed Iqbal | Anesthesiology | Aim Anesthesia LLC | 12 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 |
Lisa Ann Ciampoli | Certified Registered Nurse Anesthetist (crna) | Aim Anesthesia LLC | 12 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 |
Name | Specialty | Organization | Address |
---|---|---|---|
Emily Cottrell | Nurse Practitioner | Granite City Clinic Corp | 4273 S State Route 159, Second Floor, Glen Carbon, IL 62034 |
Michael J Walter | Critical Care (intensivists) | Granite City Clinic Corp | 4273 S State Route 159, Second Floor, Glen Carbon, IL 62034 |
Richard C Coy | Chiropractic | Optimum Wellness and Rehabilitation PC | 3407s State Route 157 1, Glen Carbon, IL 62034-1042 |
Jim Jiantao Hong | Family Medicine | 104 Magnolia Dr, Suite A, Glen Carbon, IL 62034-1595 | |
Emily A Brueggeman | Chiropractic | 108 Magnolia Dr A, Glen Carbon, IL 62034-1595 | |
Nikole L Hunter | Chiropractic | Brueggeman Chiropractic Center LLC | 108 Magnolia Dr A, Glen Carbon, IL 62034-1595 |
Haresh K Motwani | Family Medicine | 27 Auerbach Place, Glen Carbon, IL 62034-1596 | |
Barton Lynn Blackorby | Ophthalmology | Retina Consultants Ltd | 5 Country Club Executive Park, Glen Carbon, IL 62034-1702 |
Alisha A White | Internal Medicine | 4 Country Club Executive Park, Glen Carbon, IL 62034-1702 | |
Ryan J Cleland | Chiropractic | Infinite Wellness Chiropractic Ltd | 220 Evergreen Ln, Unit B, Glen Carbon, IL 62034-1714 |
Find all physicians in zip 62034 |
City | GLEN CARBON |
Zip Code | 62034 |
Specialty | PODIATRY |
City + Specialty | GLEN CARBON + PODIATRY |
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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.