Cynthia E Gannon (NPI# 1649366360, PAC ID# 1658552732) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1649366360 |
| PAC ID by PECOS | 1658552732 |
| Professional Enrollment ID | I20171108000540 |
| Full Name | Cynthia E Gannon |
| Organization Legal Name | CLEANSLATE MEDICAL GROUP OF INDIANA LLC |
| Address |
3005 E State Blvd Cleanslate Medical Group of Indiana Fort Wayne IN 46805-4736 |
| Phone Number | 2602679498 |
| Gender | F |
| Medical School | INDIANA UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1991 |
| Primary Specialty | FAMILY MEDICINE |
| Secondary Specialties | PERIPHERAL VASCULAR DISEASE |
| Group Practice PAC ID | 4880963909 |
| Number of Group Practice Members | 51 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 3005 E State Blvd, Cleanslate Medical Group of Indiana, Fort Wayne, IN 46805-4736 | 2602679498 | CLEANSLATE MEDICAL GROUP OF INDIANA LLC |
| Organization Legal Name | CLEANSLATE MEDICAL GROUP OF INDIANA LLC |
| Physicians | 47 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Melissa G Collier | Pediatric Medicine | Cleanslate Medical Group of Indiana LLC | 65 Airport Pkwy, Suite 114, Greenwood, IN 46143-1439 |
| Kathy Ann Ehler | Nurse Practitioner | Cleanslate Medical Group of Indiana LLC | 3728 S Reed Rd, Kokomo, IN 46902-3829 |
| Nora C Wilcox | Nurse Practitioner | Cleanslate Medical Group of Indiana LLC | 1725 N Meridian St, Indianapolis, IN 46202-1403 |
| Alison Arnold | Nurse Practitioner | Cleanslate Medical Group of Indiana LLC | 101 N Harrison St, Alexandria, IN 46001-2017 |
| Kumpol Dennison | General Surgery | Cleanslate Medical Group of Indiana LLC | 3005 E State Blvd, Cleanslate Medical Group of Indiana, Fort Wayne, IN 46805-4736 |
| Jessica R Bleyle | Nurse Practitioner | Cleanslate Medical Group of Indiana LLC | 4925 S Scatterfield Rd, Cleanslate Medical Group of Indiana, Anderson, IN 46013-2911 |
| Kalee M Dunkle | Nurse Practitioner | Cleanslate Medical Group of Indiana LLC | 30 Professional Ct, Suite 2, Lafayette, IN 47905-5129 |
| Donna C Robinson | Nurse Practitioner | Cleanslate Medical Group of Indiana LLC | 811 Northgate Blvd, New Albany, IN 47150-6419 |
| Ashley L Grumbine | Nurse Practitioner | Cleanslate Medical Group of Indiana LLC | 8645 Connecticut St, Merrillville, IN 46410-6222 |
| Jack R Lowe | Nurse Practitioner | Cleanslate Medical Group of Indiana LLC | 2455 E Main St, Suite 194, Plainfield, IN 46168-2715 |
| Street Address |
3005 E STATE BLVD CLEANSLATE MEDICAL GROUP OF INDIANA |
| City | FORT WAYNE |
| State | IN |
| Zip | 46805-4736 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kumpol Dennison | General Surgery | Cleanslate Medical Group of Indiana LLC | 3005 E State Blvd, Cleanslate Medical Group of Indiana, Fort Wayne, IN 46805-4736 |
| Isaiah Antonio Cruz | Nurse Practitioner | Cleanslate Medical Group of Indiana LLC | 3005 E State Blvd, Cleanslate Medical Group of Indiana, Fort Wayne, IN 46805-4736 |
| Omotayo Temitope Fawibe | Preventative Medicine | Cleanslate Medical Group of Indiana LLC | 3005 E State Blvd, Cleanslate Medical Group of Indiana, Fort Wayne, IN 46805-4736 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Alicia R Swank | Optometry | Midwest Eye Consultants PC | 431 W Coliseum, Fort Wayne, IN 46805-1010 |
| Joseph M Mattox | Family Medicine | Parkview Ortho Performance Center LLC | 3946 Ice Way, Parkview Ortho Performance Center, Fort Wayne, IN 46805-1018 |
| Jodi L Chambers | Physician Assistant | Parkview Ortho Performance Center LLC | 3946 Ice Way, Parkview Ortho Performance Center, Fort Wayne, IN 46805-1018 |
| Zubair A Khan | Optometry | Fort Wayne Vision Associates Ltd | 515 E Coliseum Blvd, Fort Wayne, IN 46805-1215 |
| Prevesh K Rustagi | Psychiatry | 3400 E Coliseum Blvd, Suite 340, Fort Wayne, IN 46805-1656 | |
| Syed M Sohail | Internal Medicine | Fort Wayne Medical Clinic PC | 3411 N Anthony Blvd, Suite 2, Fort Wayne, IN 46805-2233 |
| Aaron Christopher Frey | Optometry | Frey Vision Group of Indiana Inc | 3409 N Anthony Blvd, Fort Wayne, IN 46805-2233 |
| Myra R Weber | Optometry | Frey Vision Group of Indiana Inc | 3409 N Anthony Blvd, Fort Wayne, IN 46805-2233 |
| David S Millay | Optometry | Frey Vision Group of Indiana Inc | 3409 N Anthony Blvd, Fort Wayne, IN 46805-2233 |
| Emma Shoemaker | Optometry | Frey Vision Group of Indiana Inc | 3409 N Anthony Blvd, Fort Wayne, IN 46805-2233 |
| Find all physicians in zip 46805 | |||
| City | FORT WAYNE |
| Zip Code | 46805 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | FORT WAYNE + FAMILY 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.